![]() Surface area was assessed visually in the following way each hemiplateau was visually bisected to approximate 25% of the total surface area of the tibial plateau. In our experience, this size of defect typically does not compromise the immediate primary stability of the tibial component, but the latter was assessed separately and was a prerequisite for this technique. Resulting tibial bone defects were then considered for cement and screw augmentation if they were deep enough to accept the head of a 3.5 or 4.5 mm screw and comprised less than 15%–20% of the cut tibial surface ( figure 1). The sagittal alignment of the cut was 0°. Combined intramedullary and extramedullary tibial guidance was used, with a planned perpendicular tibial cut of 9 mm depth referenced from the centre of the lateral tibial plateau in varus knees or 6 mm from the medial plateau in valgus knees, depending on which side was worn. Procedures were performed through conventional medial (14 varus knees) or lateral (6 valgus knees) parapatellar approaches. ![]() ![]() The femoral prosthesis was deemed stable but the bone stock of the distal fragment was insufficient for fixation, and thus the fracture was treated by conversion to a rotating hinge prosthesis. X-rays at presentation showed no radiolucent lines or other signs of loosening of either component. Six patients who were not followed up and thus not included in the study were as follows: two patients had died one was lost to follow-up two refused follow-up, (although they both stated they were very satisfied with outcome of surgery) and one patient, who was initially lost to follow-up, represented after a fall 52 months postoperatively, in which he sustained a supracondylar femoral fracture. Nineteen of these patients (20 knees) were available for clinical and radiological follow-up 2 years postoperatively and were included in this study. ![]() Due to the routine protocol of follow-up and prospective collection of anonymised data in the institutional database, and the retrospective nature of the study, separate institutional review board review was not deemed necessary. Twenty-five patients (26 knees) who underwent TKA with screw and cement augmentation for bone defects and who had a 2-year follow-up were identified from a database of all TKAs performed at the institution between 20 (n=2255). ![]()
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