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Preoperative radiographs of the knees. The radiographs show bilateral severe valgus knee deformity.
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The preoperative femorotibial angles while standing were measured at 130   on the right side and 168   on the left side (Fig. 1).
Postoperative radiographs. The radiographs show the improved alignment of the lower limbs.
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TKA was performed with a lateral para-patellar approach (Keblish approach) using a constraint-type prosthesis (Triathlon TS, Stryker, Mahwah, NJ). The left TKA was performed two weeks later with a medial para-patellar approach using a posterior-stabilized type prosthesis (Triathlon PS, Stryker, Mahwah, NJ) (Fig. 2).
Radiographs of the bilateral feet and ankles. Radiographs show severe deformity of the feet and ankles. We propose the patients to be treated with arthrodesis or total ankle arthroplasty in the near future.
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Bilateral ankle deformities remained (Fig. 3).
Radiographs obtained during the clinical course after TKA. a) Radiograph at three weeks after TKA shows no fracture. b) Radiograph at seven weeks after TKA show a fracture line without callus. c) Radiograph at eleven weeks after TKA show a fracture line with callus. d) Radiograph at fifteen weeks after TKA show a fracture line with more callus. e) Radiograph at one year after TKA show that the bony union has maintained alignment.
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Reviewing the radiographs taken at seven weeks, there was a non-displaced proximal fibular fracture without callus (Fig. 4).