Total knee arthroplasty is now the most common joint replacement procedure performed worldwide and many patients require bilateral replacement. Total knee arthroplasty can provide reliable pain relief and correction of limb alignment in patients with moderate or severe arthritis. It follows that when both knees are affected by the end stage arthritis, replacement of one of the two does not fully restore function and the patient remains significantly debilitated. The surgeon and patient are then faced with the decision of whether to proceed with a staged bilateral total knee replacement, done as two unilateral procedures performed on different days, or a single stage procedure on the same day. Our aim was to assess the safety of single stage bilateral total knee arthroplasty under one anesthetic in terms of perioperative morbidity and mortality and the clinical outcome of the procedure.Fifty patients with 100 knees were studied prospectively from the time of admission to final follow up at SPARSH Hospital, Bangalore, between July 2006 to December 2008.The average postoperative knee score at 6 th month follow up was 86.4, which has a statistical significance in terms of functional outcome . Bilateral single stage procedure has definite advantages of reducing the hospital stay and early rehabilitation of the patients suffering from severe bilateral knee arthritis.