Aim <p>Periprosthetic distal femoral fractures present significant challenges in management due to high morbidity and mortality rates. We discuss the treatment options based on fracture pattern, location and status of the prosthesis.</p> Methods <p>Surgical treatment is favored over nonoperative management to enable early mobilization and prevent complications. The Rorabeck and Taylor classification system for periprosthetic fractures was used to identify the prosthesis status. For stable prosthesis, fixation method was decided based on the location of the fracture from the flange, level of comminution and bone quality.</p> Results <p>Well-fixed prosthetic components require internal fixation with locking plates either single or double or retrograde intramedullary interlocking nail. A revision knee replacement could be done in patients with loose prosthesis and good bone stock. Distal femoral replacement was required in patients with loose components and poor bone stock along with fracture. Treatment of osteoporosis is an integral part of the management. We have described a surgical algorithm to be followed based on the above protocol.</p> Conclusion <p>Treatment of periprosthetic fractures after TKA needs a tailored treatment approach based on factors such as bone quality, prosthesis stability, fracture location, and patient-specific considerations. A personalized strategy ensures optimal outcomes by addressing the unique challenges of each case and balancing the need for stability, mobility, and long-term implant survival.The surgical algorithm we have described helps in managing periprosthetic fractures effectively.</p>