Epidemiology and Classification of Distal Femoral Periprosthetic Fractures Following Total Knee Arthroplasty

Distal femoral periprosthetic fractures (DFPF) are an increasingly prevalent complication following total knee arthroplasty (TKA), representing a significant challenge to the orthopedic community. As the volume of primary and revision TKA continues to rise globally, a clear understanding of the epidemiological landscape and standardized classification are paramount for appropriate treatment, clinical communication, and research. This review provides a focused analysis of the current epidemiological propensities of DFPF, identifying the specific patient populations and temporal trends that define these injuries. Identifying, reporting, and treating DFPF requires standardized nomenclature to classify these injuries. Currently, multiple classification systems are utilized. Each system demonstrates individual strengths and weaknesses, from simple descriptive models to management-oriented frameworks. By focusing on the relationship between fracture location, implant stability, and bone stock, these systems provide algorithmic workflow for the surgical decision-making process between internal fixation construct type or the need for revision arthroplasty. As the incidence of these complex fractures continues to rise, the integration of epidemiological data with reliable classification remains essential for optimizing surgical outcomes and developing effective preventative strategies.