Correcting Severe and Bilateral Knee Deformities

Some of the cases Dr. Jangid presented involved patients who could barely walk by the time they reached his clinic, with deformities severe enough that both legs needed correcting together for the patient to stand and walk straight.

Types of severe deformity

Dr. Jangid described three recurring patterns of severe knee deformity: varus (bow-leg), valgus (knock-knee), and what he called windswept deformity, where one leg bows outward and the other inward at the same time. Bilateral knock-knee and windswept cases are typically treated together in the same patient rather than one knee at a time, since correcting only one leg leaves the patient unable to walk straight regardless. Where a fixed flexion deformity has left the knee unable to straighten even while lying down, the surrounding muscle has usually weakened over time, and these patients need a longer rehabilitation period to walk without difficulty.

What consistent outcomes require

Across all of these complex cases, Dr. Jangid described the same operating goal: minimising complications, using resources efficiently, and producing reproducible results so that every patient, not just the straightforward ones, gets a comparable outcome.

Cases that show what is possible

He shared several cases to illustrate the range of what complex deformity correction can achieve. A 130 kilogram patient from Nigeria, in severe pain and barely able to walk before surgery, was walking without any support, walker or stick within three weeks of her knee replacement. A businesswoman from Nigeria arrived in a wheelchair with all four major joints, both hips and both knees, badly damaged; both hips were replaced in a single sitting and she began walking, then both knees were replaced three weeks later, and she left India roughly ten days after that. At the time of the masterclass, around eight years on, she was still sending Dr. Jangid an annual video showing her walking normally. A separate patient with both thigh bones fractured six to seven years earlier that had never healed properly needed a complex bilateral knee replacement using extra-length stems to work around the weakened bone, without removing the old hardware already in place, and was walking again around four weeks after surgery.

This article is based on a Jivo Masterclass session conducted by Dr. Subhash Jangid, Senior Director, Orthopaedics & Joint Reconstruction, Fortis Memorial Research Institute, Gurgaon. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording

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