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Background: Rheumatoid arthritis with a patella fracture in an elderly presents technical challenges for an arthroplasty surgeon. The compromised extensor mechanism may entail a poor functional outcome in post arthroplasty period. Case report: We present a report of a 68-year-old female with pre-existing rheumatoid arthritis presenting with an acute patella fracture with patella tendon tear for management. A single stage primary knee arthroplasty with primary fixation of lower pole fracture patella with repair of extensor mechanism was done. Discussion: A staged surgery was avoided to allow for early rehabilitation. The functional outcomes are comparable to an arthroplasty for knee arthritis without a fracture.