Perioperative Anesthetic Challenges in the Management of an Early Periprosthetic Femoral Fracture Following Total Knee Arthroplasty in a High-Risk Patient: A Case Report.

Early periprosthetic distal femoral fractures following total knee arthroplasty (TKA) are uncommon but clinically significant complications requiring urgent surgical intervention. These cases pose substantial anesthetic challenges, particularly in obese patients and during early reoperation. We report the anesthetic management of a 47-year-old female patient (BMI 39 kg/m²) who underwent bilateral TKA followed by surgical fixation of a periprosthetic femoral fracture 25 days later. Both procedures were performed under combined spinal-epidural anesthesia with ultrasound-guided femoral nerve block for analgesia. This case highlights the importance of individualized anesthetic planning, neuraxial techniques, and multimodal analgesia in optimizing perioperative outcomes.