Staged Total Knee Arthroplasty for Windswept Deformity Using Primary Posterior-stabilized Components in a Resource-limited Setting

ABSTRACT: Windswept deformity, with varus alignment in one knee and valgus alignment in the contralateral knee, presents asymmetric bone loss and soft-tissue imbalance that complicate total knee arthroplasty (TKA). We report a 70-year-old male with bilateral osteoarthritis and windswept deformity, showing 15° varus on the left and 12° valgus on the right. The left knee also had a 10-mm uncontained medial tibial defect. Staged TKAs were performed 6 weeks apart in a resource-limited setting. The varus knee was reconstructed with a screw-and-cement technique and a primary posterior-stabilized (PS) prosthesis without stems or augments. The valgus knee was managed with graded lateral releases, again allowing implantation of a primary PS prosthesis. At 3 months, both knees achieved 0°-120° range of motion, marked pain relief, and improved Knee Society Scores. At 3-year follow-up, the patient remains pain-free with neutral alignment and stable implants. This case emphasizes decision-making, defect management, and soft-tissue balancing when advanced constrained implants are not routinely available.