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A 26-year-old woman with a complex sequelae of open distal femoral fracture at 4 years of age presented to the office with severe knee pain from posttraumatic osteoarthritis. Robotic arm-assisted total knee arthroplasty (RA-TKA) with the elevation of previous free-flap was performed because of the following (1) anatomic deformity, (2) small femoral size, and (3) compromised soft-tissue envelope. This case highlights the complexity of planning and performing TKA in a young patient with these unique considerations. The succes