Our experience of the management of severe bone defects in primary total knee arthroplasty with cement and screws with undersizing of tibia

Johney Juneja, Rakesh Patil, Narendra Vaidya, Ramesh Sen, Vinay Tantuway, A. K. Mehra


Background: There are several options for dealing with tibial bone defects during total knee arthroplasty in severe primary osteoarthritis. The aim of this study was to report the midterm results of TKA with screw and cement augmentation of moderate-sized tibial bone defects.

Methods: Patients with osteoarthritis who had posterior stabilised TKA with screw and cement augmentation of the tibia were reviewed retrospectively. Patients were assessed preoperatively and at follow-up using the International knee society knee score and function score, and radiographic analysis of alignment and signs of loosening.

Results: 60 knee in 60 patients were included in the study. The mean age was 71 years; mean follow-up was 58 months. KS improved from 46 to 76 and FS from 51 to 92. The femorotibial mechanical angle changed from 174 to 178. There were no signs of osteolysis or loosening, and no revisions. Radiolucent lines at the cement bone interface were common but non- progressive.

Conclusions: Midterm clinical and radiographic results of TKA with screw and cement augmentation for moderate tibial defects were satisfactory.


Bone defect, Bone cement, Screw, Total knee arthroplasty

Full Text:



Demey G, Magnussen RA, Lustig S. Total knee arthroplasty for advanced osteoarthritis in the anterior cruciate ligament deficient knee. Int Orthop. 2012;36: 559-64.

Dorr LD, Ranawat CS, Sculco TA. Bone graft for tibial defects in total knee arthroplasty. Clin Orthop. 1986;205:153-65.

Brooks PJ, Walker PS, Scott RD. Tibial component fixation in deficient tibial bone stock. Clin Orthop Relat Res. 1984;184:302-8.

Berend ME, Ritter MA, Keating EM. Use of screws and cement in primary TKA with up to 20 years follow-up. J Arthroplasty. 2014;29:1207-10.

Ritter MA. Screw and cement fixation of large defects in total knee arthroplasty. J Arthroplasty. 1986;1:125-9.

Harty LD. Medial screws and cement. J Arthroplasty. 2004;19:587-9.

Ritter MA, Keating EM, Faris PM. Screw and cement fixation of large defects in total knee arthroplasty. A sequel. J Arthroplasty. 1993;8:63-5.

Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13-4.

Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9-12.

Brand MG, Daley RJ, Ewald FC, et al. Tibial tray augmentation with modular metal wedges for tibial bone stock deficiency.1989;248:71-9.

Lee JK, Choi CH, Lee JK, Surgeon O, Choi CH. Management of tibial bone defects with metal augmentation in primary total knee replacement: a minimum five-year review. J Bone Joint Surg Br. 2011;93:1493-6.

Tsukada S, Wakui M, Matsueda M. Metal block augmentation for bone defects of the medial tibia during primary total knee arthroplasty. J Orthop Surg Res. 2013;8:36.

Lotke PA, Wong RY, Ecker ML. The use of methylmethacrylate in primary total knee replacements with large tibial defects. Clin Orthop Relat Res. 1991;270:288-94.

Freeman MA, Bradley GW, Revell PA. Observations upon the interface between bone and polymethyl-methacrylate cement. J Bone Joint Surg Br. 1982;64: 489-93.

Hvid I, Hansen SL. Trabecular bone strength patterns at the proximal tibial epiphysis. J Orthop Res. 1985;3: 464-72.

Sneppen O, Christensen P, Larsen H. Mechanical testing of trabecular bone in knee replacement. Int Orthop. 1981;5:251-6.

Dodds AL, Halewood C, Gupte CM. The anterolateral ligament: Anatomy, length changes and association with the Segond fracture. Bone Joint J. 2014;96-B:325-31.

Kosy JD, Mandalia VI, Anaspure R. Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging. Skeletal Radiol. 2015;44:1647-53.

Vincent JP, Magnussen RA, Gezmez F, et al. The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc. 2012;20:147-52.

Cuckler JM. Bone loss in total knee arthroplasty: graft augment and options. J Arthroplasty. 2004;19:56-8.

Scuderi GR, Insall JN, Haas SB. Inlay autogeneic bone grafting of tibial defects in primary total knee arthroplasty. Clin Orthop Relat Res. 1989;248:93-7.

Windsor RE, Insall JN, Sculco TP. Bone grafting of tibial defects in primary and revision total knee arthroplasty. Clin Orthop Relat Res. 1986;205:132-7.

Kawano CT, Severino NR. Autologous bone graft for tibial defects on knee total arthroplasty. Acta Ortop Bras. 2005;13:120-3.

Laskin RS. Total knee arthroplasty in the presence of large bony defects of the tibia and marked knee instability. Clin Orthop Relat Res. 1989;248:66-70.

Stockley I, McAuley JP, Gross AE. Allograft reconstruction in total knee arthroplasty. J Bone Joint Surg Br. 1992;74-B:393-7.

Hosaka K, Saito S, Oyama T, et al. Union, knee alignment, and clinical outcomes of patients treated with autologous bone grafting for medial tibial defects in primary total knee arthroplasty. Orthopedics. 2017; 40:e604-8.

Dixon MC, Parsch D, Brown RR. The correction of severe varus deformity in total knee arthroplasty by tibial component downsizing and resection of uncapped proximal medial bone. J Arthroplasty. 2004;19:19-22.