Periprosthetic distal femoral fractures (PPDFF) following knee arthroplasty represent an increasing challenge for trauma surgery and orthopedics, particularly for older multimorbid patients. Treatment concepts vary depending on the fracture type, prosthesis stability, bone quality and patient factors [1, 6–10, 13]. Depending on the fracture type and bone quality, modern locking angle plates, retrograde intramedullary nails with angulated stems, double plate and nail-plate constructs provide a high primary stability and usually enable early functional mobilization [5, 6, 11, 13, 30–33]. In very distal, osteoporotic or complex fractures, double plating is often biomechanically superior and reduce complications such as nonunion and implant failure [2, 10, 11, 13, 14, 22, 29], although there is also a risk that the bone behind the femoral shield will not properly consolidate. Distal femoral replacement is indicated in cases of extensive bone loss or primary loosening of the prosthesis [8]. Early mobilization, especially in the mostly older patient population, improves the functional outcome and reduces mortality [1, 5, 11, 13, 16, 27, 30–33]. The aim of this review article is to systematically present and evaluate current treatment options, their evidence, specific complications and functional outcomes.
