Periprosthetic knee fractures are becoming increasingly common as the prevalence of total knee arthroplasty in the general population grows. These are technically challenging fractures that often occur in an elderly patient population with multiple medical comorbidities and osteoporotic bone. In order to optimize postoperative outcomes, early mobilization is critical. Early mobilization is dependent upon achieving adequate reduction and stabilization of the fracture or conversion to a revision arthroplasty or distal femoral replacement. Surgical management is dictated by the characteristics of the fracture and the functional demands of the patient.