Periprosthetic fractures around a TKA typically involve the distal femur above a well-fixed femoral component. ORIF is typically indicated, using a retrograde nail or some form of locked plating. Tibial fractures after TKA are quite rare. In distinction to femoral fractures, fractures around a tibial component are typically associated with a loose prosthesis. Revision is indicated in this situation. Dealing with bone loss with augments, sleeves, cones, or allograft as well as stem bypass is typically necessary. Varus malalignment is often noted in these situations and should be corrected. More distal fractures can be managed with closed treatment if displacement and angulation is acceptable. A period of time in a long leg cast followed by conversion to a short leg or so-called PTB cast can be effective. More unstable fractures can be managed with plating techniques. Percutaneous so called MIPPO techniques can be particularly useful. Modern locking plates allow polyaxial proximal fixation that can be effective around the keels of tibial components. Malalignments are common so careful fluoroscopic scrutiny is necessary when using percutaneous techniques