54 years old lady a case of rheumatoid arthritis came with pain and severe valgus deformities of both knees. She also had involvement of small joints of hand and feet.

Preoperative X-Rays showed bilateral valgus deformities with severe osteoporosis. These cases require meticulous preoperative planning for correct femoral and tibial component placement.

After appropriate ligament balance this case was managed with semiconstrained primary knee prosthesis with stem extension on tibial side to prevent implant subsidence because of osteoporosis.

Post op X-Rays show well aligned bilateral semiconstrained knee prosthesis with tibial stem extension. Patient is walking comfortably with walker.