**4.2 Treatment**

Fracture treatment options in each component are related on their classified types. For supracondylar femoral fracture, Lewis and Rorabeck classification recommended nonsurgical treatment in type I, whereas treatment options either closed reduction and fixation with an intramedullary nail or open reduction and internal fixation with a plate could be performed in type II. Type III fracture requires revision of the prosthesis using a long stem or structural allograft [44]. Su et al. suggested reduction with antegrade or retrograde intramedullary nail, or sometimes a fixed-angle device for Su classification type I fracture. Su classification *Complications after Total Knee Arthroplasty: Stiffness, Periprosthetic Joint Infection… DOI: http://dx.doi.org/10.5772/intechopen.105745*

type II requires management with either a fixed-angle device or retrograde supracondylar nail, and type III fracture may be managed with either a fixed-angle device or revision arthroplasty with a stemmed femoral component. However, if loosening is identified in any classification types, revision TKA with a femoral stem is recommended [45].

Felix et al. proposed a treatment algorithm for periprosthetic tibial fractures related to their classification. For type IA, nondisplaced IIA, and IIIA fracture, nonoperative treatment with protected weight-bearing is required. If displacement is observed in type IIA and IIIA fracture, closed reduction with casting or open reduction with internal fixation is recommended. Any loosening types (IB, IIB, and IIIB) should be treated with revision arthroplasty. In case of intraoperative fracture (subcategory C), bracing with protected weight-bearing can be treated in any type if the fracture is stable and nondisplaced. However, in unstable fracture pattern or displaced fracture, further surgical management is required. Type IC fracture may be treated by screw fixation and/or a long-stemmed tibial prosthesis to bypass the fracture site. Type IIC fracture can be managed with bone grafting at the cortical defect and bypassing the fracture site with a long tibial stem. Type IIIC fracture can be treated with either closed reduction and casting or open reduction with internal fixation [46].

For treatment of patellar periprosthetic fracture, Ortiguera and Berry suggested nonoperative treatment for type I fracture. If patients developed extensor mechanism disruption with a well-fixed implant (type II), open reduction with internal fixation of the displaced fragment, or alternatively, patellectomy with advancement and repair of the extensor mechanism is recommended. Operative treatment for type IIIA fracture required revision of the patellar component or component resection with patelloplasty, whereas implant removal with patellectomy is recommended for type IIIB fracture [36].

In the elderly, physiologic changes of bone, especially a high rate of bone resorption, result in diminishing bone mass and strength [48]. Osteoporosis workup and treatment are necessary in addition to fracture management in patients with periprosthetic fracture after TKA.
