Primary hydatidosis of the tibia is a rare disease. In an endemic area, it should be considered in the differential diagnosis of a hypolucent osteolytic lesion on xray. If not properly managed, anaphylactic shock may occur intraoperatively, as well as increased reccurence of the disease. This is a case report of a primary tibial hydatid cyst, treated first with curettage and phenolizaton, and then after recurrence, treated with total knee arthroplasty. We will review the literature of diagnosis and treatment of a hydatid cyst of the tibia.