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The management of the tibial bone defects in primary TKA is a challenging aspect of knee surgery. Reconstruction of tibial bone defects has to restore the optimum maximal surface of bone-prosthesis interface and also has to maintain the rectangularity between tibial mechanical axis and joint line. The type and the size of the bone defects are the major concerns regarding the surgical technique choose for the reconstruction of these defects. Between 2000 - 2009 from 427 primary TKA 37 necessitated reconstruction of bone defects. 2 cases were treated by lateralization and downsizing of the tibial component, cement filling of the defect for 14 cases, autologous bone grafting for 12 cases, 2 of, 12 cases have necessitated stem protection. Nine cases have been operated with metallic wedge and stem. The average follow-up has been of 18 months, and we have evaluated radiological aspects and also the functional outcome using KSS scale. For all cases when we used the bone defects cement filling technique, the functional outcome was excellent. With an average follow-up of 6 months we have found out that all the autologous grafts have been integrated, and that the functional outcome has been also very good.