With an increasingly aging population, the number of patients undergoing knee replacement is increasing each year. At the same time, the incidence of periprosthetic fractures is also increasing year by year as the average age of patients increases and expectations for postoperative functional recovery continue to rise. Periprosthetic fractures are difficult to treat in the clinic because of their specific fracture type, and their outcome directly affects the quality of life of patients. The choice of treatment for periprosthetic fractures of the femoral side of the knee depends on the fixation of the prosthesis, the location of the fracture, and whether the femoral prosthesis is open between the condyles. Most scholars believe that locking plates have better clinical efficacy than other fixation methods because they can be placed minimally invasively, minimize local blood flow disruption, and achieve angular stability. However, considering the impact on the patient’s health and the impact on the body after reoperation, some scholars believe that although locking plate fixation is theoretically more reliable, the clinical results are not as good as expected. A recent study published in the Journal of Arthroplasty by Dr. Nabil A. Ebraheim of the University of Toledo confirms this view. The authors treated 27 periprosthetic fractures of the femoral side of the knee with internal fixation using a contralateral distal femoral lateral locking plate (smith&nephew, Priloc plate). The mean age of the patients was 75.07 years and the mean time from admission to surgery was 2.6 days (2-3 days). Temporary fixation was performed with Kirschner pins after satisfactory repositioning under direct vision and fluoroscopy, internal fixation was installed, double cortical fixation was given to the osteochondral site, and appropriate allograft bone graft was given to those with poor bone quality or severe fracture comminution. Cefazolin and enoxaparin were given before and after surgery to prevent infection and blood clots (cefazolin for 3 days and enoxaparin for 6 weeks). Imaging and clinical follow-up were performed at 2, 6, 12, 24, and 48 weeks postoperatively. All patients were followed up until at least fracture healing and full weight-bearing of the limb. The mean follow-up was 7.6 months (3-36 weeks). All patients achieved good postoperative repositioning and alignment. The time to fracture healing and full weight bearing was 4.5 ± 2.7 months, and the healing rate at 6 months was 89%. A total of 37% of patients had complications, with two cases of osteonecrosis or delayed fracture healing (7.4%, considered to be related to perioperative infection) and seven cases of screw or plate extraction due to inexact fixation (26%). All patients with failed fixation were treated with re-internal fixation, and wire ties were given if inadequate fixation was found intraoperatively. Normally, blood flow to the femur is supplied from the proximal to the distal end of the femur. After knee replacement, the lateral blood supply to the femur is often disrupted to varying degrees. Implantation of the prosthesis causes stress masking of the distal femur, making the fracture more likely to occur at the femoral prosthetic union and leaving the surgeon with more limited options for fixation. In addition, the strength of the strong fixation is not conducive to the growth of the bone scab. In addition, the patient’s bone mass level and the lack of cortical bone in the distal femur also affect the stability of fracture fixation. Taken together, the treatment of periprosthetic fractures of the distal femur is extremely difficult and its complication rate is higher than it should be. The authors of this study concluded that the application of a contralateral distal femoral lateral locking plate for the treatment of these more difficult periprosthetic fractures of the distal femur is not as effective as expected and that more attention should be given to these fractures to reduce the occurrence of complications.