Periprosthetic femur fracture (PPFF) around a hip arthroplasty implant is a known complication following hip replacement surgery that is expected to increase in incidence with the growing numbers of arthroplasties being performed around the world. These cases are challenging due to the presence of the implant, variable bone stock, and frailty of the patients most likely to sustain these injuries. These fractures pose a significant financial cost to the medical system as well, with a reported cost of £23,469 per patient in the UK and hospital costs of up to $34,000 for PPFF treated with revision arthroplasty in the USA. Most of these fractures occur in patients in their seventh decade of life, with a reported risk of 1–2.3% for primary total hip arthroplasty and 1.5–7.8% for revision total hip arthroplasty. Periprosthetic fracture can occur either intraoperatively or postoperatively. Identified risk factors for periprosthetic femur fracture include increasing age, osteoporosis, use of uncemented implants, revision arthroplasty, and prior prosthetic joint infection (PJI). These injuries are associated with a significant rate of perioperative mortality, up to 21.7% at 12 months, equivalent to that of native hip fractures.