Sequential Bilateral Total Knee Arthroplasty for Advanced Varus Osteoarthritis

The patient reported progressive bilateral knee pain, markedly reduced walking capacity, difficulty reaching the toilet at night and sleep disturbance due to persistent pain. Clinical examination demonstrated varus deformity and instability, although the deformity remained correctable to neutral under anaesthesia. Long-leg weight-bearing radiographs were used to assess hip–knee–ankle alignment, deformity, bone loss and osteophyte burden. The patient had hypertension and a cardiac conduction abnormality but preserved cardiac function. Anaesthetic management included a combined spinal–epidural technique with bilateral adductor canal blocks. The epidural catheter was planned for postoperative analgesia during the initial rehabilitation period.

1. Sequential bilateral total knee arthroplasty was performed
2. A midline skin incision and medial parapatellar arthrotomy were used
3. Intramedullary femoral and extramedullary tibial guides were used
4. Trial reduction identified tight flexion and extension gaps
5. The definitive components were implanted using a pressurised