There has been increasing interest in performing acute total knee replacement for periarticular knee fractures in elderly osteoporotic patients. This is comparable to treating femoral neck fractures with arthroplasty. We present a case of tuberculous infection in a primary total knee replacement performed for a medial tibial condyle fracture, in an 85-year-old Caucasian female with a previously asymptomatic knee. The incidence of tuberculosis is gradually increasing. We highlight the problem with musculoskeletal tuberculosis in relation to the delay in diagnosis and subsequent initiation of treatment.