Managing a bone defect in primary total knee arthroplasty is challenging and requires careful pre operative planning. Intra operative assessment is necessary to classify the bone defects and to decide the appropriate bone replacement and prosthetic components. The treatment options for managing a bone defect in primary total knee arthroplasty are cement filling, bone grafting with screw augmentation, autologous bone grafting, translating the prosthesis, modular components. Each one has its advantages and disadvantages and specific indications. Of which we opted bone graft with screw augmentation for stable bone prosthesis interface.

Case Report

A 56 years old female presented with a history of knee pain and instability for 5 years who had previous history of trauma and associated restriction of activities daily living. After pre operative evaluation of the bone defects, total knee replacement was planned. Intra operatively bone defects was assessed and classified based on Rand classification (Rand-typeIIb). Total knee arthroplasty with bone grafting augmented with screw fixation was done.


Patient was followed up for 8 months and assessed clinically, radiologically without osteolysis and good graft uptake with restoration of gait. There was excellent knee society score on follow up. Of the various treatment modalities, bone grafting with screw augmentation was one of the standard treatment options.