Periprosthetic tibial fractures following total knee arthroplasty are rare; they are generally related either to an unrecognized intraoperative weakening of the tibial cortex or to an actual traumatic event occurring in an osteoporotic context. Their management requires careful assessment of the tibial component’s stability, the location of the fracture line, and the patient’s overall condition. This literature review addresses the following questions: (1) What are the epidemiology, mechanisms, and classification of these fractures? (2) Is there still a role for conservative (non-operative) management? (3) What are the surgical specificities and fixation options? (4) When and how should revision of the tibial component be considered? (5) What is the recommended approach in the event of an intraoperative fracture? (6) What outcomes and complications have been reported in the literature?