Periprosthetic fractures around the knee often occur in elderly patients. Frailty and sarcopenia add to other comorbidities to make these patients acutely susceptible to blood loss anemia. Therefore, careful consideration of initial, ongoing, and perioperative blood loss must be taken, especially with femoral fractures.

Many of these patients are on anticoagulation, which predisposes them to increased blood loss at the time of injury. Medical co-management for reversal of anticoagulation should be considered. Fracture stabilization usually helps to prevent ongoing blood loss. Therefore, these patients benefit from timely surgery. Medical workup, blood transfusion, and reversal of anticoagulation should be done expeditiously to avoid delaying fracture repair.

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