Management Bone Defects

AORI / Andersen Orthopedic Research Institute


T Tibial  F Femoral


1.  Contained Metaphyseal Defect


2.  Damaged Metaphyseal

A.  One Condyle

B.  Both Condyles


3.  Deficient Metaphysis +/- collaterals +/- extensor mechanism


1.  Contained Metaphyseal defect 


Revision TKR AORI Tibia Type 1 APRevision TKR AORI Tibia Type 1 Lateral




A.  Bone graft defects


B.  Standard +/- Revision TKR


Revision TKR Type 1 DefectRevision TKR Type 1 Defect Lateral


2.  Damaged Metaphysis


A One condyle


B Both


Revision TKR AORI Tibia Type 2 B APRevision TKR AORI Tibial Type 2 B Lateral


Revision TKR Tibial Lysis 2BRevision TKR Damaged Tibial Metaphysis




A.  Cement < 1cm


Revision TKR Bone Defect Cement APRevision TKR Bone Defect Cement Lateral.jpg


B.  Augments < 2cm


Revision TKR Tibial AugmentsRevision TKR Augments


C.  Bone graft


3.  Deficient Metaphysis +/- collaterals / quads


Revision TKR Deficient Femoral Metaphysis


Revision TKR Deficient Metaphysis APRevision TKR Deficient Metaphysis Lateral




A.  Bulk structural allograft

- femoral head


Engh et al JBJS Am 2007

- bulk structure allograft in the tibia in 46 patients followed for 8 years

- 2 deep infections

- average knee society scores 84

- no graft collapse or loosening


B.  Tantalum cones metaphyseal filling / Trabecular metal


Revision TKR Tantalum APRevision TKR Tantalum Lateral


Meneghini et al JBJS Am 2009

- tantalum porous tibial implant in 15 pateints followed average 3 years

- AORI type 3 and type 2B

- knee society score average 85

- all had evidence osteointegration, no loosening


Howard et al JBJS Am 2011

- femoral tantalum components in 24 knees followed for averag 3 years

- knee society score average 81

- all well fixed with no complications


C.  Mesh + impaction bone grafting


D.  Tumour prosthesis / Custom implants


Revision TKR Tumour ImplantRevision TKR Tumour