Periprosthetic fractures after total knee arthroplasty present substantial challenge if associated with poor bone stock, fracture comminution, and loose or damaged components. Revision total knee arthroplasty with distal femoral arthroplasty is often necessary in these injuries. We reviewed 20 patients (22 knees) with a mean age of 69.5 years who underwent revision with distal femoral arthroplasty fracture. Patients were followed for an average of 58.6 months. At the latest follow-up, the mean Knee Society knee and functional score were 82.8 and 40, and the Short Form 36 mean physical functioning and mental functioning scores were 55.8 and 65.6, respectively. There were 10 postoperative complications with 5 patients requiring additional surgery. Distal femoral arthroplasty seems to be a viable option for complex periprosthetic femoral fractures after total knee arthroplasty. However, considering the relatively high rate of complications, this procedure should be reserved for patients where alternative treatments are not possible.
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