INTRODUCTION: Juvenile idiopathic arthritis (JIA) poses lifelong challenges due to chronic inflammation that can lead to permanent deformities like autofusion, severely affecting quality of life. CASE REPORT: In this case, a 31-year-old female with a 21-year history of bilateral knee pain secondary to JIA faced a unique challenge: bilateral knee autofusion. Radiographs revealed severe bilateral contractures, erosive changes, and autofusion, prompting the decision for simultaneous total knee arthroplasties (TKAs). Evaluation at 1-year postoperatively showed significant improvements in function, pain, and activities of daily living. CONCLUSION: This case provides insight into outcomes of simultaneous TKAs in the context of autofusion, highlighting the procedure's viability in resolving debilitating knee conditions, even in the presence of complex factors such as JIA.