Deficiencies in Vitamin D effects the growth and development of a children leading to rickets. Presentation of childhood Rickets patients include delayed growth and bowed legs leading to back and arthritis of the knees and hip. We describe a 45-year-old Chinese female with Childhood Rickets and SLE who presented with bilateral knee pain for the past 8 years. This short stature lady had an antalgic gait, marked genu varum on both knees and had limited range of motion of the knees. She undergo total knee arthroplasty for both knee on two different setting. Special consideration unique to this patient population can be discussed such as challenges faced in difficult primary total knee arthroplasty, types of implant to choose to achieve balanced knee, as well as functional problems that may arise post operatively. The patient had a good outcome from her surgery, however this paper alone may not represent all the patient with angular deformity of knees who undergo total knee arthroplasty.