Primary total knee arthroplasty in patients with a significant bone defect in the medial tibial plateau: Case series and literature review

INTRODUCTION AND IMPORTANCE: Total knee arthroplasty (TKA) can significantly enhance a patient's quality of life and knee function. As a result, it has become a popular procedure among orthopedic surgeons. However, there are some challenging cases that surgeons may encounter, such as treating bony defects in the tibial plateau in patients with advanced degeneration. If not managed properly, these cases can have serious consequences. CASE PRESENTATION: 4 patients with severe knee joint degeneration and bone loss in the medial tibial plateau were included in the series. The patients underwent TKA using the cement and screws technique to compensate for the defect in the medial tibial plateau. After (12-24 months) follow-up, all patients showed a clear clinical and functional improvement. CLINICAL DISCUSSION: Several ways exist to address bone loss in the tibial plateau in primary total knee joint arthroplasty. Among them, metal prostheses are frequently used. In certain situations, we may need to use more affordable techniques to ensure success for patients facing financial difficulties. This is particularly common in our country, and we may utilize methods such as the cement and screws technique. This study showed a clear improvement in the patient's clinical and functional outcomes according to The Western Ontario and McMaster Universities Arthritis Index (WOMAC) at the end of the follow-up period. CONCLUSION: The cement and screw technique might be a good solution for moderate bone loss in the tibial plateau. It might be a safe and simple method for patients, and it's also a viable option for those who can't afford pricier alternatives like metal augmentation or structural allografts.