This report describes an operative technique for the treatment of periprosthetic fractures of the knee with instability of the metaphysis and the metadiaphyseal junction that stabilizes the metaphyseal fragment by a distraction technique using trabecular metal cones. Fifteen patients were examined clinically and radiologically for a follow-up period of 36.7 ± 8.7 months. The Knee Society Score improved to 73.2 ± 20.2 by 24 months after surgery; the function score improved to 68.3 ± 20.2 by 24 months after surgery. The mean flexion amounted to 94.4 ± 9.7 degrees by 24 months after surgery. The only complication was one case of thrombosis. This technique involving trabecular metal cones to stabilize metaphyseal fractures seems to represent a further option for fixation of periprosthetic fractures that are otherwise treated with megaprostheses.