Managing bone defects in primary total knee arthroplasty: options and current trends

While tackling with bone deficiencies in the context of total knee arthroplasty, it is imperative for the arthroplasty surgeon to arm himself with an in-depth knowledge on the various management options available and to use the right option for the right type of defect in the right patient. Aim of this review paper is to focus on the various options available and discuss the evolving concepts and recent trends with regard to the implications and treatment of bone deficiencies, in primary total knee arthroplasty. Relevant literature is evaluated with specific focus on the modality used for managing a defect, their clinical and radiological outcomes and failure rates. Out of various classifications described, Anderson Orthopaedic Research Institute (AORI) system is universally employed to classify the bone defects. The currently available management options include more tibial resection, the use of bone cement to fill the defect, with or without augmentation with screws, bone grafting which may be autograft or allograft, metal augments, metaphyseal cones and sleeves. There is no single option which can be applied universally; each has its own advantages, disadvantages and specific indications with regard to application in specific types of defects, in specific patients as outlined in this article.