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Spontaneous insufficiency fracture of the knee is a potentially devastating yet poorly understood disease entity that can lead to secondary osteoarthritis. Most cases involve the medial femoral condyle, and the lateral femoral condyle is rarely affected. The optimal treatment for spontaneous insufficiency fracture of the lateral femoral condyle remains undetermined, and there are no previous dedicated reports on treatment outcome with unicompartmental knee arthroplasty. A middle-aged lady presented with subacute left knee pain and a locked knee. Subsequent imaging studies revealed a spontaneous insufficiency fracture of the lateral femoral condyle. In view of the isolated compartment involvement, unicompartmental knee arthroplasty was performed with satisfactory outcome. At 1 year postoperatively, the patient had complete resolution of knee pain and was able to resume working.