We had a 65-year-old male who came for the treatment of his patella fracture and deformity of knee. His knee society score was 70 for the left knee and 78 for the right knee. It was known that he was having multiple comorbidities such as hypertension and coronary artery disease. There was a history of percutaneous transluminal coronary angioplasty 1 year back. He had a history of fall from two wheelers 1 month back, and he sustains injury to his left knee. The patient was having pain, swelling, but he had not taken any treatment for it. Patient neglected the injury and was able to walk with the support of walking aid. On examination, the patient was having bilateral knee Varus 20°9 () and fixed flexion deformity of 30°. Active straight leg raising was not possible on the left side. Range of movement of left knee was possible from 30 to 90°. Radiographs revealed a transverse fracture of the patella with Grade 4 osteoarthritic changes on the left side and arthritic changes on right knee also (). Other findings of blood investigations were normal. We decided to go for single-stage procedure with fixation of patella fracture and TKR. Anterior midline incision was taken, and medial parapatellar arthrotomy was done. On extensor side the retinaculum was found intact intraoperatively, so we first proceed with TKR. Calcified medial meniscus was excised, and posteromedial tibial defect was taken care with downsizing of the tibia. After through irrigation with normal saline and debridement of soft tissue from articular side of patella fracture, the fracture ends were approximated. Reduction held with patella pointed reduction clamps and two parallel K wires. An 18 G SS wire was used for tension band wiring of patella. The extens or retinaculum was reinforced with absorbable sutures ( and ). The incision was closed in layers without a suction drain. Post-operative radiographs showed an acceptable reduction of the fracture and an acceptable TKR. In postoperative period patient was allowed early knee mobilization up to 90°, and full weight bearing was allowed with the help of walking aid. At the end of 3 months patient achieved range of motion 5-110° and his knee society score improved to 90. The patella fracture united completely without any complication ()