Management of Bone Loss in Primary and Revision Knee Replacement Surgery

Total knee arthroplasty (TKA) often deal with bone defect localized in areas corresponding to tibial and femoral articular surfaces, a condition that is often observed in revision knee prosthetic surgery but occasionally in primary arthroplasty of the knee too. Such intraoperative situation, could create a main problem in maintaining proper alignment of the implant components and in establishing sufficient bone stock to achieve a stable boneimplant interface. The surgeon must assess the degree of complexity preoperatively and intraoperatively and have a broad armamentarium available during surgery. Multiple surgical options are available to repair or reconstruct the loss of bone, these include: bone cement, bone grafts, metal augments and custom-made implants. Principles to consider in bone loss management are knee-related (particularly defect size and location, ligament stability, limb alignment) and patient-related (age, body mass index, activity level, life expectancy).