{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T23:03:46Z","timestamp":1789772626762,"version":"4.0.1"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The number of total knee arthroplasty (TKA) procedures performed continues to rise annually. As projections show a continued increase in these surgeries, it is important to identify patients at risk for certain complications. Distal femur periprosthetic fractures around TKA can pose notable morbidity to patients, while also imparting a marked burden on the health system. This systematic review aims to identify patient and implant characteristics that increase the risk of distal femur periprosthetic fractures. Three common literature databases were searched for \u201cdistal femur periprosthetic fracture.\u201d The resulting studies were screened for relevance and inclusion and exclusion criteria, followed by an in-depth review of various patient and implant characteristics. Thirteen studies were included in this systematic review. Despite some variation across the studies, the most common population for distal femur periprosthetic fractures was females, over the age of 70, with the American Society of Anesthesiologists (ASA) score of III. These most often occurred in a low-energy trauma or falls from standing. Additionally, when compared to native distal femur fractures, there is evidence that periprosthetic fracture patients are older, have a higher body mass index (BMI), are more commonly osteopenic or osteoporotic, and less commonly sustain these injuries as part of polytrauma. As we continue to perform increasing numbers of TKAs, identifying patients at risk for periprosthetic fractures aids in patient counseling and preventive care. This can allow patients to optimize modifiable risk factors before and after undergoing TKA in an effort to avoid sustaining periprosthetic distal femur fractures.<\/jats:p>","DOI":"10.1055\/a-2871-7249","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T23:16:08Z","timestamp":1778541368000},"page":"620-625","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors for Distal Femoral Periprosthetic Fractures after Total Knee Arthroplasty: A Systematic Review of Patient and Implant Variables"],"prefix":"10.1055","volume":"39","author":[{"given":"Lawrence","family":"Jajou","sequence":"additional","affiliation":[{"name":"Lenox Hill Hospital, New York, United States","place":["New York"],"department":["Department of Orthopedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4087-0599","authenticated-orcid":false,"given":"James","family":"Germano","sequence":"additional","affiliation":[{"name":"Long Island Jewish Valley Stream, New York, United States","place":["Valley Stream"],"department":["Department of Orthopedics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giles R.","family":"Scuderi","sequence":"additional","affiliation":[{"name":"Northwell Health, Lenox Hill Hospital, New York, United States","place":["New York"],"department":["Department of Orthopedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"issue":"01","key":"ref1","first-page":"e22.00112","article-title":"Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040\u20132060","volume":"8","author":"I Shichman","year":"2023","journal-title":"JB JS Open Access"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/BOT.0000000000000282","article-title":"Periprosthetic femur fractures","volume":"29","author":"W M Ricci","year":"2015","journal-title":"J Orthop Trauma"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/2151458514542281","article-title":"Mortality and financial burden of periprosthetic fractures of the femur","volume":"5","author":"E Shields","year":"2014","journal-title":"Geriatr Orthop Surg Rehabil"},{"issue":"71","key":"ref4","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"M J Page","year":"2021","journal-title":"BMJ"},{"issue":"10","key":"ref5","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/BOT.0000000000002649","article-title":"Primary and periprosthetic distal femur fractures in older adults: No difference in 12-month mortality and patient-reported outcomes","volume":"37","author":"A M Mather","year":"2023","journal-title":"J Orthop Trauma"},{"issue":"11","key":"ref6","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1055\/s-0042-1749604","article-title":"Comparable outcomes between native and periprosthetic fractures of the distal femur","volume":"36","author":"M W Kaufman","year":"2023","journal-title":"J Knee Surg"},{"issue":"07","key":"ref7","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1016\/j.injury.2021.05.007","article-title":"Outcomes of periprosthetic distal femur fractures following total knee arthroplasty: Intramedullary nailing versus plating","volume":"52","author":"E B Gausden","year":"2021","journal-title":"Injury"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1186\/s13018-024-04796-8","article-title":"Clinical differences between periprosthetic and native distal femur fractures: A comparative observational study","volume":"19","author":"S Kong","year":"2024","journal-title":"J Orthop Surg Res"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1097\/BOT.0000000000002624","article-title":"Outcomes of geriatric periprosthetic distal femur fractures: Comparison of fixation versus reconstruction","volume":"37","author":"N M Joseph","year":"2023","journal-title":"J Orthop Trauma"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/BOT.0000000000002730","article-title":"Retrograde intramedullary nailing versus locked plating for extreme distal periprosthetic femur fractures: A multicenter retrospective cohort study","volume":"38","author":"N L Van Rysselberghe","year":"2024","journal-title":"J Orthop Trauma"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s00402-025-06173-4","article-title":"Challenging the myth: Comparing early complications of native and periprosthetic distal femur fractures. The role of implant stability","volume":"146","author":"C Lampert","year":"2026","journal-title":"Arch Orthop Trauma Surg"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.arth.2024.10.006","article-title":"Fix or replace? Comparable outcomes with internal fixation and distal femoral replacement for periprosthetic fractures above total knee arthroplasty","volume":"40","author":"J D Lizcano","year":"2025","journal-title":"J Arthroplasty"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1016\/j.arth.2025.09.007","article-title":"Nail-plate combination fixation for periprosthetic distal femoral fractures allows early weight-bearing with low reoperation and revision rates","volume":"41","author":"R E Bilodeau","year":"2025","journal-title":"J Arthroplasty"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1007\/s00068-024-02530-x","article-title":"Retrograde intramedullary nail fixation with oblique fixed angle screws versus locking plates in periprosthetic supracondylar fractures after total knee arthroplasty","volume":"50","author":"F Rudolph","year":"2024","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"S 01","key":"ref15","doi-asserted-by":"crossref","first-page":"111351","DOI":"10.1016\/j.injury.2024.111351","article-title":"Periprosthetic fracture around total knee arthroplasty: What are the advantages of minimal-invasive surgery?","volume":"55","author":"C Chantelot","year":"2024","journal-title":"Injury"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.jor.2024.02.039","article-title":"Outcomes of operatively managed periprosthetic distal femur fractures compared to fractures in patients with native knees","volume":"53","author":"N Bostrom","year":"2024","journal-title":"J Orthop"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.jor.2022.09.005","article-title":"Surgical outcomes of periprosthetic distal femur fractures after total knee arthroplasty classified by Su et al. system","volume":"34","author":"M Mazur","year":"2022","journal-title":"J Orthop"},{"issue":"10","key":"ref18","doi-asserted-by":"crossref","first-page":"2615","DOI":"10.1016\/j.arth.2024.05.033","article-title":"Risk and epidemiology of periprosthetic knee fractures after primary total knee arthroplasty: A nationwide cohort study","volume":"39","author":"S K Risager","year":"2024","journal-title":"J Arthroplasty"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1302\/0301-620X.93B1.25087","article-title":"The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement","volume":"93","author":"R M Meek","year":"2011","journal-title":"J Bone Joint Surg Br"},{"issue":"08","key":"ref20","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1007\/s43465-025-01336-2","article-title":"Periprosthetic distal femoral fractures: Current concepts and management strategies","volume":"59","author":"D R Palanisami","year":"2025","journal-title":"Indian J Orthop"},{"issue":"05","key":"ref21","doi-asserted-by":"crossref","first-page":"382","DOI":"10.14740\/jocmr2970w","article-title":"Gender disparities in osteoporosis","volume":"9","author":"K A Alswat","year":"2017","journal-title":"J Clin Med Res"},{"issue":"07","key":"ref22","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.injury.2012.01.025","article-title":"Outcome of periprosthetic distal femoral fractures following knee arthroplasty","volume":"43","author":"M F Hoffmann","year":"2012","journal-title":"Injury"},{"issue":"02","key":"ref23","doi-asserted-by":"crossref","first-page":"170","DOI":"10.3109\/17453674.2013.788436","article-title":"Predictors of periprosthetic fracture after total knee replacement: an analysis of 21,723 cases","volume":"84","author":"J A Singh","year":"2013","journal-title":"Acta Orthop"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1080\/17453674.2021.1892267","article-title":"International variation in distribution of ASA class in patients undergoing total hip arthroplasty and its influence on mortality: data from an international consortium of arthroplasty registries","volume":"92","author":"A J Silman","year":"2021","journal-title":"Acta Orthop"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1007\/s11999-009-0876-9","article-title":"Intraoperative fracture during primary total knee arthroplasty","volume":"468","author":"K J Alden","year":"2010","journal-title":"Clin Orthop Relat Res"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1007\/s12306-025-00927-4","article-title":"Anterior femoral notching during total knee arthroplasty: a predictor of periprosthetic femoral fractures?","author":"V Benkovich","year":"2025","journal-title":"Musculoskelet Surg"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"00091","DOI":"10.2106\/JBJS.RVW.20.00091","article-title":"Periprosthetic fractures through tracking pin sites following computer navigated and robotic total and unicompartmental knee arthroplasty: A systematic review","volume":"9","author":"T J Smith","year":"2021","journal-title":"JBJS Rev"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2871-7249.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:54:20Z","timestamp":1789772060000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2871-7249"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":27,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,9,18]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2871-7249","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5,11]]},"published":{"date-parts":[[2026,5,11]]}}}