Avascular necrosis (AVN) of tibial condyles is an uncommon cause of joint degeneration and it may mimic osteoarthritis. The differentiation between spontaneous and secondary osteonecrosis is important for appropriate management. We present here a case of spontaneous avascular necrosis of the medial tibial condyle causing sudden increase in pain; localization to the medial tibial condyle near joint line with exacerbation on weightbearing and varus deformity. We also aim to recapitulate briefly various types and currently available treatment options. In the present case, considering advanced stage of AVN and associated degenerative changes, total knee replacement (TKR) was performed successfully with good outcomes.

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