Customized tibial trays, methods, and systems for knee replacement

A tibial tray system for a resurfaced proximal portion of a tibia for a patient includes, for example, a tibial tray and at least one screw. The tibial tray includes a body having a superior portion, and an inferior tibia-engaging portion having a peripheral inferiorly-extending portion contactable with an underlying cortical bone and/or spaced apart from the underlying inner surface of the cortical of the tibia of the patient. In some embodiments in the total knee replacement, a greater portion of a shearing force acting transversely on the tibial tray and the resected portion of the proximal portion of the tibia of the patient is resisted by the at least one inferiorly-extending wall and the periphery of the resected proximal portion of the tibia compared to a portion of the shearing force being resisted along the center inferior surface of the tibial tray and the resected cancellous bone surface.