Periprosthetic fractures of the tibia are less commonly encountered and have received less attention than periprosthetic fractures of the patella and distal femur. In contrast with distal femoral fractures, tibial fractures frequently are encountered with loose implants and treatment often requires simultaneous revision knee surgery to address the loose prosthesis, the fracture, and any associated bone deficiencies. In some instances, fractures associated with well-fixed and satisfactorily positioned knee components may be treated by traditional methods of operative or nonoperative fracture management. A classification system, which accounts for the anatomic location of the fracture, the status of prosthesis fixation, and timing of the fracture is helpful in description of the various fracture patterns and direction of the appropriate treatment approach.