Background: Non-traumatic distal femoral insufficiency fractures are rare but increasingly recognized after total knee arthroplasty (TKA), particularly in osteoporotic patients. This case series analyzes clinical features, risk factors, and treatment outcomes in 11 affected patients.

Methods: Retrospective analysis included 11 female patients (mean age 62.3 years) with postoperative atraumatic distal femoral fractures after TKA at a tertiary center (2018-2025). Demographics, risk factors, surgical details, fracture classification, treatment, and complications were extracted.

Results: All were female (mean BMI 32.1). Varus deformity present in 81.8%, valgus in 18.2%; femoral notching in 27.3%. Most fractures (63.6%) involved the lateral condyle. Seven patients had osteoporosis, all received posterior-stabilized implants. Treatments included conservative management, ORIF (1, failed), revision constrained implants, and distal femoral replacement. One failure occurred after ORIF.

Conclusions: Distal femoral insufficiency fractures after TKA predominantly affect osteoporotic women early postoperatively. Risk factors include varus alignment, posterior-stabilized implant, and high BMI. Prompt diagnosis and tailored treatment optimize recovery.

Mohamed Magdy is a Lecturer of Orthopedic Surgery at Zagazig University Hospitals, Egypt. He obtained his MD degree at the age of 33 and has since developed a focused expertise in knee arthroplasty. His clinical and academic work is dedicated to advancing surgical techniques and improving patient outcomes in joint replacement surgery.