Conventional Total Knee Arthroplasty in Severe Anterolateral Femoral Bowing: Lateralized Femoral Entry Point to Approach Navigation Level Alignment – A Case Report

Introduction: Severe knee osteoarthritis associated with anterolateral femoral bowing presents unique challenges for achieving accurate alignment during total knee arthroplasty (TKA). Extra-articular deformity may prevent proper positioning of the femoral cutting block, increasing the risk of malalignment. This case is important because it illustrates a simple and accessible technique to manage substantial femoral bowing without relying on navigation or robotic technology. Case Report: We report the case of an 84-year-old woman with end-stage left knee osteoarthritis and marked anterolateral femoral bowing, treated with cemented posterior-stabilized TKA. A key technical adaptation was the use of a deliberately lateralized femoral intramedullary (IM) entry point, allowing alignment of the IM guide with the patient's mechanical axis despite the deformity. The patient recovered uneventfully and demonstrated progressive improvement. At 6 months, she walked independently without walking aids and had full functional recovery. Conclusion: In cases of significant femoral bowing, intentional lateralization of the femoral entry point is crucial for achieving accurate mechanical alignment using conventional instrumentation. This technique is practical, reproducible, and particularly useful when advanced computer-assisted systems are unavailable.