Repairing minor bone defects: augmentation & autograft.

Numerous options exist for management of minor bone defects associated with TKA. Biomechanical data demonstrate that filling defects with methylmethacrylate, with or without screw augmentation, results in inferior load transfer. Rectangular augmentations may be superior to angular wedges due to reduction in shear stresses. Controversy persists regarding superiority of use of bone graft versus augmentation. The author favors bone graft for cavitary defects, massive bone loss, and in younger patients in whom additional revision surgery is likely. Prosthetic augmentation is favored in peripheral defects of moderate size in more elderly patients.