Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 4 3 2020 05 07 59 61 SM Javad Mortazavi Professor, Department of Orthopedic Surgery, Joint Reconstruction and Research Center,Tehran University of Medical Sciences, Tehran, Iran Furqan Khan 2Fellowof Knee Surgery, Joint Reconstruction and Research Center, Tehran University of Medical Sciences, Tehran, Iran Ahmed Ramezanpour Resident, Departmentof Orthopedic Surgery, Joint Reconstruction and Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammad Firoozabadi Resident, Departmentof Orthopedic Surgery, Joint Reconstruction and Research Center, Tehran University of Medical Sciences, Tehran, Iran 2019 10 03 2020 01 14 Background: Post-traumatic arthroplasty is associated with higher rates of complications and overall inferior outcomes when compared with primary joint replacement. The literature revealed no precise guidelines on the management of nonunion of Hoffa fracture. Hence, we tried to elicit a management protocol in such patients from the literature perspective. Case Presentation: A 62-year-old patient survived a car accident with a distal femoral fracture in the coronal plane (Hoffa fracture) and was treated with open reduction and internal fixation (ORIF). Three years later, the patient developed nonunion with post-traumatic arthritis (PTA). Owing to joint degeneration and poor bone quality, the patient was treated with total knee arthroplasty (TKA). One year follow-up showed excellent outcomes. Conclusions: Inpatient with healthy joint surface and good bone density, treatment of choice should be ORIF and in those with joint degeneration and low bone stock, arthroplasty is a better choice.     https://jost.tums.ac.ir/index.php/jost/article/view/115 https://jost.tums.ac.ir/index.php/jost/article/download/115/127