{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:55:21Z","timestamp":1790934921594,"version":"4.1.0"},"reference-count":55,"publisher":"Bioscientifica","issue":"10","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Periprosthetic fractures around total knee arthroplasty are an increasingly common and complex problem driven by rising arthroplasty volumes, aging populations, and longer implant survivorship. Successful management requires integration of trauma principles with arthroplasty-specific considerations, particularly implant stability, bone stock, and patient frailty. Implant stability and bone quality are the primary determinants of treatment strategy, outweighing fracture morphology alone. Classification systems are useful frameworks but must be interpreted in the context of component fixation and host factors. Fixation using locked plating, retrograde intramedullary nailing, or combined constructs is appropriate for stable implants with adequate bone stock and achieves high union rates, while preserving bone and future revision options, particularly important in younger or active patients. Revision arthroplasty with stemmed components, cones or sleeves, and appropriate constraint is indicated for loose components or compromised bone stock, offering durable reconstruction but with complication profiles similar to complex revision total knee arthroplasty. Distal femoral replacement serves as an effective salvage option for fractures that cannot be fixed or in frail, low-demand patients, enabling immediate weight-bearing but at the cost of higher complication and re-revision rates. Overall, outcomes depend not only on fracture union but also on restoration of alignment, extensor mechanism function, and early mobilization. High complication rates reflect the combined burden of fragility fracture biology and revision arthroplasty complexity, underscoring the need for individualized, patient-centered decision-making.<\/jats:p>","DOI":"10.1530\/eor-2026-0075","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:13:15Z","timestamp":1790932395000},"page":"1015-1027","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-16","source":"Crossref","is-referenced-by-count":0,"title":["Periprosthetic fractures of the knee"],"prefix":"10.1530","volume":"11","author":[{"given":"Kerstina","family":"Menzel","sequence":"first","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t Zu Berlin 1 , ,","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0993-581X","authenticated-orcid":true,"given":"Carsten","family":"Perka","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t Zu Berlin 1 , ,","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panayiotis D","family":"Megaloikonomos","sequence":"additional","affiliation":[{"name":"First Department of Orthopedics, National and Kapodistrian University of Athens, Attikon University General Hospital 2 , ,","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5614-5431","authenticated-orcid":true,"given":"Henryk","family":"Haffer","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t Zu Berlin 1 , ,","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana Gonz\u00e1lez","family":"Khatib","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t Zu Berlin 1 , ,","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"Gwinner","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t Zu Berlin 1 , ,","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil","family":"Schemitsch","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Orthopaedic Surgery, University of Western Ontario 3 , , ,","place":["London, Ontario, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Braun","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t Zu Berlin 1 , ,","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"2026100205131192500_bib1","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-B","author":"Meek","year":"2011","journal-title":"J Bone Joint Surg Br"},{"key":"2026100205131192500_bib3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1055\/s-0033-1333901","article-title":"Classification and treatment of periprosthetic supracondylar femur fractures","volume":"26","author":"Ricci","year":"2013","journal-title":"J Knee Surg"},{"key":"2026100205131192500_bib5","doi-asserted-by":"crossref","first-page":"e746","DOI":"10.5435\/JAAOS-D-22-00701","article-title":"Periprosthetic fractures after total knee arthroplasty","volume":"31","author":"Bengoa","year":"2023","journal-title":"J Am Acad Orthop Surg"},{"key":"2026100205131192500_bib6","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1007\/s11999-010-1530-2","article-title":"Mortality after distal femur fractures in elderly patients","volume":"469","author":"Streubel","year":"2011","journal-title":"Clin Orthop Relat Res"},{"key":"2026100205131192500_bib10","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1007\/s00198-023-06746-2","article-title":"The impact of prior fragility fractures on long-term periprosthetic fracture risk following total knee arthroplasty","volume":"34","author":"Agarwal","year":"2023","journal-title":"Osteoporos Int"},{"key":"2026100205131192500_bib7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1055\/s-0033-1333900","article-title":"Periprosthetic fractures about the knee - an overview","volume":"26","author":"Della Rocca","year":"2013","journal-title":"J Knee Surg"},{"key":"2026100205131192500_bib15","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/00003086-199712000-00016","article-title":"Periprosthetic fractures of the tibia associated with total knee arthroplasty","volume":"345","author":"Felix","year":"1997","journal-title":"Clin Orthop Relat Res"},{"key":"2026100205131192500_bib21","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1097\/BOT.0b013e318207885b","article-title":"Biomechanics of far cortical locking","volume":"25","author":"Bottlang","year":"2011","journal-title":"J Orthop Trauma"},{"key":"2026100205131192500_bib13","doi-asserted-by":"crossref","first-page":"12","DOI":"10.5435\/00124635-200401000-00003","article-title":"Periprosthetic femur fractures above total knee replacements","volume":"12","author":"Su","year":"2004","journal-title":"J Am Acad Orthop Surg"},{"key":"2026100205131192500_bib14","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S0030-5898(05)70081-X","article-title":"Periprosthetic fractures of the femur complicating total knee arthroplasty","volume":"30","author":"Rorabeck","year":"1999","journal-title":"Orthop Clin North Am"},{"key":"2026100205131192500_bib22","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":"Hoffmann","year":"2012","journal-title":"Injury"},{"key":"2026100205131192500_bib23","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.otsr.2012.10.014","article-title":"Distal femur fractures. Surgical techniques and a review of the literature","volume":"47","author":"Ehlinger","year":"2013","journal-title":"Orthop Traumatol Surg Res"},{"key":"2026100205131192500_bib27","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.knee.2020.11.009","article-title":"Long-term results of revision total knee arthroplasty using a rotating hinge implant","volume":"28","author":"Wignadasan","year":"2021","journal-title":"Knee"},{"key":"2026100205131192500_bib31","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1302\/2633-1462.33.BJO-2021-0202.R1","article-title":"Survivorship, complications, and outcomes following distal femoral arthroplasty for non-neoplastic indications","volume":"3","author":"Sobol","year":"2022","journal-title":"Bone Jt Open"},{"key":"2026100205131192500_bib2","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/01.blo.0000126306.87452.59","article-title":"The modular segmental kinematic rotating Hinge for non-neoplastic limb salvage","volume":"421","author":"Springer","year":"2004","journal-title":"Clin Orthop Relat Res"},{"key":"2026100205131192500_bib4","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S0883-5403(98)90187-5","article-title":"Interprosthetic fracture of the femoral shaft","volume":"13","author":"Kenny","year":"1998","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib8","doi-asserted-by":"crossref","first-page":"662","DOI":"10.3928\/01477447-20100722-37","article-title":"Management of bone loss in revision TKA: it\u2019s a changing world","volume":"33","author":"Lombardi","year":"2010","journal-title":"Orthopedics"},{"key":"2026100205131192500_bib9","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.arth.2007.05.041","article-title":"Osteolysis after total knee arthroplasty","volume":"22","author":"Gupta","year":"2007","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib11","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.arth.2020.08.052","article-title":"Revision Total Knee Arthroplasty in Young Patients: Higher Early Reoperation and Rerevision","volume":"36","author":"Walker-Santiago","year":"2021","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib12","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1302\/0301-620X.96B6.34040","article-title":"The Unified Classification System (UCS): improving our understanding of periprosthetic fractures","volume":"96-B","author":"Duncan","year":"2014","journal-title":"Bone Joint J"},{"key":"2026100205131192500_bib24","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1080\/17453670710014716","article-title":"Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981-2006)","volume":"79","author":"Herrera","year":"2008","journal-title":"Acta Orthop"},{"key":"2026100205131192500_bib50","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/j.arth.2022.01.078","article-title":"New classification for periprosthetic distal femoral fractures based on locked-plate fixation following total knee arthroplasty: a multicenter study","volume":"37","author":"Kim","year":"2022","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib17","doi-asserted-by":"crossref","first-page":"743","DOI":"10.5435\/JAAOS-D-18-00083","article-title":"Evaluation of the Painful Total Knee Arthroplasty","volume":"27","author":"Flierl","year":"2019","journal-title":"J Am Acad Orthop Surg"},{"key":"2026100205131192500_bib18","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1097\/BOT.0b013e3181d73508","article-title":"Interprosthetic femoral fractures","volume":"24","author":"Mamczak","year":"2010","journal-title":"J Orthop Trauma"},{"key":"2026100205131192500_bib19","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.3390\/jcm11051371","article-title":"Peri- and Interprosthetic Femoral Fractures-Current Concepts and New Developments for Internal Fixation","volume":"11","author":"K\u00f6sters","year":"2022","journal-title":"J Clin Med"},{"key":"2026100205131192500_bib20","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.arth.2018.02.078","article-title":"The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria","volume":"33","author":"Parvizi","year":"2018","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib39","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/BOT.0b013e31816ed989","article-title":"Periprosthetic knee fractures","volume":"22","author":"Parvizi","year":"2008","journal-title":"J Orthop Trauma"},{"key":"2026100205131192500_bib48","doi-asserted-by":"crossref","first-page":"235","DOI":"10.2106\/JBJS.25.00498","article-title":"Risk factors for nonunion following lateral locked plating of distal femoral fractures: a Bayesian analysis of 560 patients","volume":"108","author":"Wagner","year":"2026","journal-title":"J Bone Joint Surg Am"},{"key":"2026100205131192500_bib45","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/j.injury.2020.02.043","article-title":"Equivalent union rates between intramedullary nail and locked plate fixation for distal femur periprosthetic fractures: a systematic review","volume":"51","author":"Shah","year":"2020","journal-title":"Injury"},{"key":"2026100205131192500_bib51","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1530\/EOR-21-0113","article-title":"Double fixation for complex distal femoral fractures","volume":"7","author":"Stoffel","year":"2022","journal-title":"EFORT Open Rev"},{"key":"2026100205131192500_bib56","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1007\/s00068-025-02871-1","article-title":"Evolving fracture management: the role of helical plating in orthopaedic trauma surgery\u2014a narrative review","volume":"51","author":"Kraus","year":"2025","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026100205131192500_bib57","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s00590-025-04176-w","article-title":"Immediate full weight-bearing, reduced perioperative morbidity and mortality after surgery in the treatment of distal femur fractures using a standard lateral plate plus a helical moulded medial plate osteosynthesis","volume":"35","author":"Molina-Olivella","year":"2025","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2026100205131192500_bib42","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.injury.2015.10.030","article-title":"Retrograde femoral nailing of periprosthetic fractures around total knee replacements","volume":"47","author":"Jones","year":"2016","journal-title":"Injury"},{"key":"2026100205131192500_bib43","doi-asserted-by":"crossref","first-page":"e92","DOI":"10.1097\/BOT.0000000000002236","article-title":"Periprosthetic supracondylar femoral fractures above a total knee replacement: an updated compatibility and technique guide for fixation with a retrograde intramedullary nail","volume":"36","author":"Gerow","year":"2022","journal-title":"J Orthop Trauma"},{"key":"2026100205131192500_bib44","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1016\/j.arth.2013.07.027","article-title":"Periprosthetic supracondylar femoral fractures above a total knee replacement: compatibility guide for fixation with a retrograde intramedullary nail","volume":"29","author":"Thompson","year":"2014","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib46","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1016\/j.arth.2025.09.007","article-title":"Nail\u2013plate combination fixation for periprosthetic distal femoral fractures allows early weight-bearing with low reoperation and revision rates","volume":"41","author":"Bilodeau","year":"2026","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib25","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s00590-025-04542-8","article-title":"Nail plate construct in complex distal femur fractures allow safe, early unrestricted weight bearing with high rates of union and a low rate of failure: five-year experience at a UK major trauma centre","volume":"35","author":"Barrow","year":"2025","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2026100205131192500_bib26","doi-asserted-by":"crossref","DOI":"10.1177\/21514593211070128","article-title":"Early weight-bearing after distal femur fixation","volume":"13","author":"Striano","year":"2022","journal-title":"Geriatr Orthop Surg Rehabil"},{"key":"2026100205131192500_bib54","doi-asserted-by":"crossref","DOI":"10.1016\/j.otsr.2022.103489","article-title":"Treatment of supracondylar periprosthetic femoral fractures with retrograde intramedullary nailing versus distal femoral plating: a systematic review and meta-analysis of current evidence","volume":"109","author":"Wall","year":"2023","journal-title":"Orthop Traumatol Surg Res"},{"key":"2026100205131192500_bib55","doi-asserted-by":"crossref","DOI":"10.1016\/j.otsr.2024.103814","article-title":"SOFCOT members. Management of periprosthetic femoral fractures following total knee arthroplasties using locking plates or intramedullary nailing: comparative study of 567 cases","volume":"110","author":"Abboud","year":"2024","journal-title":"Orthop Traumatol Surg Res"},{"key":"2026100205131192500_bib52","first-page":"56","article-title":"Comparison of outcomes of retrograde intramedullary nailing versus locking plate fixation in distal femur fractures: a systematic review and meta-analysis of 936 patients in 16 studies","volume":"37","author":"Aggarwal","year":"2023","journal-title":"J Orthop"},{"key":"2026100205131192500_bib53","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/BOT.0000000000002482","article-title":"Locked lateral plating versus retrograde nailing for distal femur fractures: a multicenter randomized trial","volume":"37","author":"Dunbar","year":"2023","journal-title":"J Orthop Trauma"},{"key":"2026100205131192500_bib28","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1016\/j.arth.2017.01.013","article-title":"Development and Verification of Novel Porous Titanium Metaphyseal Cones for Revision Total Knee Arthroplasty","volume":"32","author":"Faizan","year":"2017","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib29","doi-asserted-by":"crossref","first-page":"S263","DOI":"10.1016\/j.arth.2022.02.074","article-title":"Survivorship of Metaphyseal Cones and Sleeves in Revision Total Knee Arthroplasty","volume":"37","author":"Heidenreich","year":"2022","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib30","doi-asserted-by":"crossref","first-page":"5365","DOI":"10.1007\/s00167-023-07572-z","article-title":"Condylar constrained and rotating hinged implants in revision knee arthroplasty show similar survivorship and clinical outcome: a systematic review and meta-analysis","volume":"31","author":"Stroobant","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"2026100205131192500_bib32","doi-asserted-by":"crossref","first-page":"3959","DOI":"10.1016\/j.arth.2021.08.013","article-title":"Distal Femoral Replacement and Periprosthetic Joint Infection After Non-Oncological Reconstruction: A Retrospective Analysis","volume":"36","author":"Sukhonthamarn","year":"2021","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib47","doi-asserted-by":"crossref","first-page":"S457","DOI":"10.1016\/j.arth.2025.05.033","article-title":"Comparison of survivorship of distal femoral replacements by the fixation method","volume":"40","author":"Hohmann","year":"2025","journal-title":"J Arthroplast"},{"key":"2026100205131192500_bib33","first-page":"175","article-title":"Extensor mechanism allograft reconstruction after total knee arthroplasty","volume":"87","author":"Burnett","year":"2005","journal-title":"J Bone Joint Surg Am"},{"key":"2026100205131192500_bib38","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s00113-025-01642-2","article-title":"Periprothetische frakturen am knie","volume":"129","author":"Meier","year":"2026","journal-title":"Unfallchirurgie"},{"key":"2026100205131192500_bib49","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.2106\/JBJS.24.01094","article-title":"Metaphyseal fixation in revision total knee arthroplasty","volume":"107","author":"Megaloikonomos","year":"2025","journal-title":"J Bone Joint Surg Am"},{"key":"2026100205131192500_bib36","doi-asserted-by":"crossref","first-page":"532","DOI":"10.2106\/00004623-200204000-00004","article-title":"Patellar fracture after total knee arthroplasty","volume":"84","author":"Ortiguera","year":"2002","journal-title":"J Bone Joint Surg Am."},{"key":"2026100205131192500_bib37","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1055\/s-0033-1353991","article-title":"Periprosthetic patellar fractures","volume":"26","author":"Sassoon","year":"2013","journal-title":"J Knee Surg"},{"key":"2026100205131192500_bib40","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/00003086-198811000-00013","article-title":"Patellar fracture type and prognosis in condylar total knee arthroplasty","volume":"236","author":"Goldberg","year":"1988","journal-title":"Clin Orthop Relat Res"},{"key":"2026100205131192500_bib34","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s42836-022-00134-7","article-title":"Evolving etiologies and rates of revision total knee arthroplasty: a 10-year institutional report","volume":"4","author":"Brown","year":"2022","journal-title":"Arthroplasty"},{"key":"2026100205131192500_bib35","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1302\/0301-620X.84B8.0841093","article-title":"Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology","volume":"84","author":"Perren","year":"2002","journal-title":"J Bone Joint Surg Br"}],"container-title":["EFORT Open Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.bioscientifica.com\/eor\/article-pdf\/11\/10\/1015\/526076\/eor-2026-0075.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/eor\/article-pdf\/11\/10\/1015\/526076\/eor-2026-0075.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:13:22Z","timestamp":1790932402000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.bioscientifica.com\/eor\/article\/11\/10\/1015\/78312\/Periprosthetic-fractures-of-the-knee"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":55,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,1]]},"published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1530\/eor-2026-0075","relation":{},"ISSN":["2058-5241"],"issn-type":[{"value":"2058-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]}}}