Bone grafts are a useful option to treat large posteromedial defects in tibia which are usually seen in medial condyle of the tibia in severe varus knees and lateral condyle in valgus knees. Contained defects can be treated using cancellous bone chips/graft. Uncontained peripheral defects may be treated using cement with or without screw augmentation for small defects. Large defects > 25 % of tibial plateau and > 5 mm deep may need structural bone graft or impaction bone grafting or metal wedges. The use of bone grafts is a viable alternative for the treatment of massive bone loss.

For stable fixation of the components, we performed osseous reconstruction of tibial condyle using autologous structural bone grafts /impaction bone grafting. We used structural bone graft for 62 tibial defects in severe varus knees in 675 primary TKR. Grafts originating from the femoral condyles were fixed with screws. Morselised autograft supported by mesh, fixed with screws, were used in 8 patients. Bilateral bone grafting was done in 28 patients. Goal was to obtain firm seating of the tibial tray on a rim of viable bone along with rigid press fixation of the medullary stem.

We observed an average 70-point postoperative increase in knee function according to HSS score. Graft incorporation was seen in all patients at average seven year follow-up.

Autologous bone grafts can be successfully used for reconstruction of large osseous defects. It is available then and there, is biological and cost effective.