94 patients with periprosthetic distal femur fractures above a total knee arthroplasty (TKA) were randomized to receive either locked plating or retrograde intramedullary nailing. The outcomes of interest for this secondary analysis were general health outcomes measured using the EuroQol-5 Dimensions (EQ-5D) Index and Visual Analogue Scale (VAS), and the 12-Item Short Form Survey (SF-12), both the Physical Component Score (PCS) and Mental Component Score (MCS). Mortality was also evaluated. Outcomes were assessed at regular intervals up to 2 years postoperatively. Overall, the results of the study revealed no significant differences between locked plating and retrograde intramedullary nailing in general health outcomes throughout follow-up, with the exception of a higher EQ-5D VAS score at 6 weeks in the locked plating group. Mortality rates were also similar between groups. These findings suggest that both fixation strategies provide comparable long-term health related quality of life outcomes for periprosthetic distal femur fractures above a TKA.