Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 11 1 2026 08 03 9 14 Vrajesh Shah Department of Orthopaedics, Joint Replacement Unit, VIROC Super Speciality Hospital, Vadodara, Gujarat, India. Rajiv Paradkar Department of Orthopaedics, Joint Replacement Unit, VIROC Super Speciality Hospital, Vadodara, Gujarat, India. Tanmay Jaisinghani Department of Orthopaedics, Joint Replacement Unit, VIROC Super Speciality Hospital, Vadodara, Gujarat, India. Nandlal Bharwani Department of Orthopaedics, Joint Replacement Unit, VIROC Super Speciality Hospital, Vadodara, Gujarat, India. 2025 10 13 2026 05 24 The deformity around the knee joint is considered extra-articular when it is proximal in relation to the distal femur epicondyle for the femur and distal to the level of the fibula neck for the tibia deformity. The presence of extra-articular deformity plays a significant role in arthritis around the adjacent joint. The present study shows a case of malunited proximal tibia fracture with knee osteoarthritis treated with restricted kinematic alignment total knee arthroplasty. For end-stage OA with extraarticular deformity, a well-balanced total knee replacement with robotic assistance can be done without complete intra-articular correction of extra-articular deformity. A 65-year-old male presented to the outpatient department (OPD) with a complaint of bilateral knee pain from the past six months. The radiographs showed end-stage knee osteoarthritis with a malunited proximal tibia fracture on the right side. For the right knee, total knee arthroplasty (TKA) was planned using robotic assistance with restricted kinematic alignment, which consists of bone cuts of the distal femur, proximal tibia, and soft tissue release. For the management of knee arthritis as a result of tibial side extra-articular deformity, it can be managed with bone resections and soft tissue balancing followed by total knee replacement. https://crcp.tums.ac.ir/index.php/crcp/article/view/1119 https://crcp.tums.ac.ir/index.php/crcp/article/download/1119/769