During revision total knee arthroplasty, the surgeon notes significant bone loss of the medial tibial plateau classified as Anderson Orthopaedic Research Institute (AORI) type IIB. The most appropriate reconstructive strategy for this contained peripheral defect of >10 mm depth is:

• A Cement filling alone
• B Structural allograft with cemented stemmed component
• C Conversion to hinged total knee prosthesis without addressing bone loss
• D Tibial baseplate augment (metal wedge or block) ✓

Explanation

AORI type IIB represents a contained peripheral defect >5 mm requiring structural support on one or both condyles with compromised but intact rim. Metal augments (wedges or modular blocks) attached to the tibial baseplate are the standard of care for this classification, restoring the joint line without the biologic risks of allograft. Cement alone is appropriate only for contained defects <5 mm (type I). Structural allograft with stemmed components is reserved for AORI type III (massive segmental loss). The implant design choice depends on collateral ligament integrity, not merely on bone loss.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.