Complex Primary Total Knee Arthroplasty for Severe Bilateral Genu Varum with Fixed Flexion Deformity: Mechanical Axis Restoration, Soft-tissue Balancing, and Functional Recovery.
Amit Kale, Pankaj Sharma, Sudheer Goli
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Case in brief
A 50-year-old man presented with progressive bilateral knee pain and impaired walking and daily activities. Examination showed marked genu varum and fixed 25° flexion deformities in both knees; radiographs demonstrated grade IV osteoarthritis with complete medial joint-space loss and approximately 22° varus malalignment. He underwent simultaneous bilateral cemented posterior-stabilized total knee arthroplasty, with measured bone resections, osteophyte removal, sequential medial release, and flexion-extension gap balancing. At 1 year, he walked independently without pain, had stable knees, full extension and 120° flexion, and near-neutral alignment. Knee Society scores improved, and no early complication was reported.
What made this case unusual
The reconstructive challenge was the combination of severe bilateral varus malalignment and fixed flexion deformity, requiring correction and balanced gaps in both knees during simultaneous arthroplasty.
Diagnostic / clinical pearl
In severe varus knees with flexion contracture, careful preoperative planning and systematic bone resection, osteophyte removal, medial release, and gap balancing can support alignment correction while avoiding instability.