A prospective study of thirty-two cases of total knee replacement with reconstruction of tibial defects, in twenty-eight patients was performed between 2001 and 2004 at Kasr el- Eini hospitals. Twenty cases were primary total knee replacements and twelve cases were revision total knee replacements. Reconstruction of the defects was performed by autogenous bone grafts or metal wedges and blocks. Modified Knee Society Scoring system was used for patients scoring and follow-up in our study. At final follow up examination, 78% of cases (25 cases) were excellent, 19% of cases (6 cases) were good and 3% of cases (one case) were fair according to function scoring. According to knee scoring 41% of cases (13 cases) were excellent results, 59% of cases (19 cases) were good results.