Periprosthetic supracondylar femur fracture after total knee arthroplasty is a potentially devastating complication with an incidence of 0.3% to 2.5%. As the population ages and the indications for knee arthroplasty expand, the incidence of these fractures is expected to rise. Significant risk factors include osteopenia, female sex, rheumatoid arthritis, chronic steroid use, and anterior femoral notching. Classification of these fractures by displacement and prosthetic stability can be used as a guide for treatment. Nonoperative treatment is recommended for undisplaced fractures above a stable arthroplasty. Operative fixation is favored for displaced fractures above a stable implant, although the optimal fixation device remains controversial. The presence of an unstable prosthesis associated with a fracture that is either undisplaced or displaced is most commonly treated with revision arthroplasty, although data for this treatment recommendation are limited.
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