Management Strategies for Tibial Periprosthetic Fractures After Total Knee Arthroplasty

Tibial periprosthetic fractures following total knee arthroplasty are relatively uncommon, but represent a complex and increasingly encountered complication given the growing volume of primary and revision arthroplasty procedures. These injuries present unique challenges due to compromised bone stock, implant-related constraints, and patient-specific factors such as advanced age and osteoporosis. The location of the fracture, implant stability, bone quality, and the functional needs of the patient all influence management tactics. While operative intervention is frequently necessary for displaced fractures or those linked to component loosening, nonoperative treatment may be suitable in certain individuals who have stable implants and slightly displaced fractures. Proximal tibial replacement in extreme situations, revision arthroplasty using stemmed components, and open reduction and internal fixation are surgical possibilities. This review summarizes current classification systems, treatment strategies, and outcomes, with an emphasis on practical decision-making. A treatment strategy centered first on implant stability and then on fracture pattern, bone stock, and patient factors provides the most useful framework for clinical decision-making.