Bone grafts for bone loss with total knee replacement

Predictable and reproducible use of bone graft for reconstruction of defects with total knee replacement requires (1) surface preparation of host bone to expose a viable bony bed, (2) definition of the defect and preparation of the graft so that excellent fit and fixation are obtained, (3) coverage of the graft by the component to prevent resorption of unstressed graft which may compromise the press-fit of the graft and lead to failure by collapse, (4) protection of the graft from overload by correct alignment of components and limb and by limited weight-bearing until union occurs, (5) protection of the graft by use of a stemmed component when indicated. In the knee, bone grafts can be expected to be successful in 90 to 95 per cent of patients if the above principles are followed. Failed grafts can be salvaged by a second graft or by use of custom components if the bone is judged to have united.