Periprosthetic Distal Femoral Fracture Following Total Knee Arthroplasty Associated With Anterior Femoral Notching: A Case Report

Periprosthetic distal femoral fractures are uncommon but potentially serious complications following total knee arthroplasty (TKA). Several patient-related and surgical factors contribute to their occurrence, including osteoporosis, trauma, implant malalignment, and technical factors such as anterior femoral notching. Femoral notching, caused by violation of the anterior femoral cortex during femoral preparation, has been suggested to weaken the structural integrity of the distal femur and increase susceptibility to fracture. However, the association between femoral notching and periprosthetic fracture remains controversial. We report the case of a 47-year-old woman who developed a periprosthetic distal femoral fracture following bilateral TKA. Radiographic evaluation demonstrated a supracondylar femoral fracture adjacent to the femoral component with evidence of anterior femoral notching. The patient presented with acute knee pain and functional limitation during early postoperative rehabilitation. Surgical fixation was performed, followed by a structured rehabilitation program. This case highlights the potential biomechanical implications of anterior femoral notching during TKA. Although periprosthetic fractures are multifactorial in origin, cortical violation may act as a stress riser that predisposes the distal femur to fracture. Careful surgical technique and vigilant postoperative monitoring may help reduce the risk of this complication.