{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:57:48Z","timestamp":1785488268807,"version":"3.56.0"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Severe bilateral genu varum associated with end-stage medial compartment osteoarthritis is a technically demanding indication for total knee arthroplasty (TKA). The principal reconstructive problems are fixed coronal malalignment, medial soft-tissue contracture, posterior osteophytes, flexion contracture, asymmetric tibial bone loss, and the need to obtain rectangular flexion and extension gaps without causing postoperative instability. A 50-year-old male presented with progressive bilateral knee pain for 1 year, more severe on the right side, with difficulty in walking, stair climbing, squatting, and sitting cross-legged. He had no history of trauma, inflammatory arthritis, diabetes, hypertension, or cardiovascular disease. Examination showed bilateral swelling, diffuse tenderness, obvious genu varum, fixed flexion deformity of 25\u00b0 in both knees, and preserved distal neurovascular status. Radiographs showed Kellgren-Lawrence grade IV osteoarthritis with complete medial joint-space loss, osteophytes, tibial beaking, and approximately 22\u00b0 of varus malalignment on long-leg assessment. Intervention: After routine medical optimization, simultaneous bilateral cemented posterior-stabilized TKA was performed through a medial parapatellar approach. Correction was achieved using measured bone resections, removal of medial\/posterior osteophytes, sequential medial release, posterior cruciate ligament sacrifice, 3\u00b0 posterior tibial slope, and equalization of 18-mm flexion and extension gaps. Outcome: Mobilization began on the postoperative day 1 and discharge occurred on day 5. At 1 year, the patient had painless independent ambulation, stable knees, full extension, 120\u00b0 of flexion, near-neutral alignment, Knee Society knee score improvement from 45 to 90, function score improvement from 40 to 85, and VAS pain reduction from 8\/10 to 1\/10. No infection, thromboembolism, instability, or early radiological complication occurred. This case highlights that severe bilateral varus knees can be corrected with simultaneous bilateral Posterior-stabilized PS-TKA in carefully selected patients when preoperative planning, systematic bone resection, medial release, and gap balancing are executed meticulously.<\/jats:p>","DOI":"10.4103\/aam.aam_556_26","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:01:18Z","timestamp":1785484878000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Complex Primary Total Knee Arthroplasty for Severe Bilateral Genu Varum with Fixed Flexion Deformity: Mechanical Axis Restoration, Soft-tissue Balancing, and Functional Recovery"],"prefix":"10.4103","author":[{"given":"Amit","family":"Kale","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Dr. D. Y. Patil Medical Hospital, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankaj","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudheer","family":"Goli","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,30]]},"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_556_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:01:18Z","timestamp":1785484878000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_556_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":0,"URL":"https:\/\/doi.org\/10.4103\/aam.aam_556_26","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]},"assertion":[{"value":"2026-05-03","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}