A 64-year-old man with Charcot arthropathy secondary to tabes dorsalis had bilateral knee arthroplasties performed. Twelve years after the replacement of the right, and six years after replacement of the left, both knees are pain-free with good function and radiological alignment. This successful outcome can be explained by the fact that the patient was only mildly ataxic, and that he had persistence of pain sensation in his lower limbs. Arthroplasty could have a role in the management of Charcot knee.