I. Introduction
Proximal tibial bony deficiencies are frequent conditions in primary and revision total knee arthroplasty. The surgical treatment of these lesions depends on the size and location of the defect. The patient's age and bone quality are other important factors in choosing the type of reconstruction. In primary knee replacement the most frequent bone defect is located postero-medially on tibial plateau and is always associated with an important varus deformity of the knee. Due to different sizes and shapes of these defects a lot of surgical techniques have been developed to restore the tibial plateau's shape and integrity. The aim of this reconstruction is to have a tibial plateau as strong as possible to support the tibial component of the knee prosthesis. For the long term survivalship of the implant it is essentially to have a uniform load distribution of the forces on tibial bone and the implant should be fully supported by the bone. There are several causes leading to these defects in primary knee replacement: a neglected advanced osteoarthritis with varus or valgus more than 25°, fractures, rheumatoid arthritis, avascular necrosis or failed tibial osteotomy. Techniques frequently used in surgical practice include filling minor defects with cement, augmentation of cement with screws, wires or mesh, bone grafting (structural or morselized) or metal augmentation with blocks or wedge.