Background <p> Periprosthetic fractures (PPF) are increasing in incidence alongside an ageing population and expanding arthroplasty services. Although PPF are included within national hip fracture databases and share similar standards of care, their greater surgical complexity and resource utilisation is not formally recognised by current frameworks.</p> Aim <p> To compare acute inpatient resource utilisation between patients sustaining periprosthetic femoral fractures and those sustaining hip fractures in a regional orthopaedic trauma unit.</p> Methods <p> A single-centre retrospective study was performed including 45 consecutive operatively managed PPF cases (January 2022–June 2024), matched 2:1 with 90 consecutive hip fracture patients (January–June 2024). Demographics, frailty, American Society of Anesthesiologists (ASA) grade, time to surgery, operative duration, length of stay, critical care utilisation, and inpatient mortality were analysed.</p> Results <p> Baseline demographics were homogenous between groups. Patients with PPF waited significantly longer for surgery (mean delay 1.75 days, p&lt;0.0001) and had longer operative times (mean increase 61.5 minutes, p&lt;0.0001). Length of stay was similar between groups (16.75 vs 15.88 days, p=0.67). PPF patients were less frail but more frequently required post-operative critical care admission (15.6% vs 4.4%, p=0.04). Inpatient mortality was higher in the PPF group, though not statistically significant.</p> Conclusion <p> Periprosthetic fractures have a substantially greater acute healthcare burden than hip fractures, particularly in terms of operative time, surgical delay, and critical care utilisation, despite similar mortality rates, lengths of stay and lower frailty scores. These findings highlight the need for recognition of PPF complexity and consideration of enhanced resource allocation for centres managing high PPF volumes.</p>