Role of Distal Femoral Replacement for Periprosthetic Fractures Above a Total Knee Arthroplasty: When and How?

With increasing incidence of total knee arthroplasty (TKA), a concurrent rise in periprosthetic fractures is also expected. Although many periprosthetic fractures about a TKA can be fixed through locked plating, retrograde intramedullary nailing, or both, some fracture patterns combined with poor bone stock and/or osteolysis can offer a loose femoral component requiring TKA revision. TKA revision in the setting of periprosthetic fracture can be challenging and, often, nearly impossible as fractures that extend proximally may not be amenable to standard revision components. Distal femoral replacement may offer a more efficient, facile approach to treating periprosthetic fractures about a loose TKA component. Here, the role of distal femoral replacement is reviewed, offering indications, salient technical points, and tips to avoid pitfalls while allowing for immediate, reliable weight bearing in this challenging patient population.