Supracondylar and distal femoral fractures involving total knee arthroplasties present a relatively new and challenging problem. The alignment of the total knee components prior to and subsequent to the fracture, as well as the patients' range of motion, symptoms, and level of function following their treatment, were investigated in 14 cases. Ten of the patients had nonoperative treatment. Four had had an operative procedure. Osteoporosis, notching of the femur, and revision arthroplasty were identified as predisposing factors with femoral fractures. The results of treatment depended primarily on reduction of varus deformity and/or posterior displacement of the femoral component. Nonoperative treatment was most successful in this regard.