Periprosthetic total knee arthroplasty fractures of the distal femur and proximal tibia can be among the most difficult complications to effectively manage within the realm of joint replacement. These fractures can occur intraoperatively or postoperatively. Intraoperative fractures can be avoided by early removal of hardware, use of stems for stress risers, and use of intraoperative radiographs whenever further visualization is required. Intraoperative fractures should be fixed and then protected by a stem and avoidance of weight bearing until healed. Postoperative fractures can occur with significant trauma, or minor injury when osteolysis is present. Operative management is almost always required. The method of treatment depends upon factors such as the stability of implant fixation, location of the fracture, quality of the bone, and presence or absence of an open-box femoral component.