Bone loss in total knee arthroplasty: graft augment and options.

The alternatives available for management of bone defects in total knee arthroplasty include prosthetic augments, autograft, allograft, and the use of bone cement. The selection of the augment technique should be based on the defect size, the patient age and life expectancy, and an assessment of the documented clinical results of each method. Prosthetic augments will address the vast majority of defects. The use of allograft is primarily indicated in the setting of major bone loss in revision knee arthroplasty, whereas the use of autograft is appropriate in the management of small defects in primary arthroplasty. Bone cement can be used for small defects if the stability of the implant is not compromised by the defect.