Periprosthetic femoral fractures following total hip and total knee arthroplasty

•Joint arthroplasty prevalence is increasing rapidly, as is fracture incidence.•Up to 2.5% and 3.5% fracture around primary TKA and THA respectively.•Reduced bone quality increases risk of periprosthetic fracture.•Risk is much higher in uncemented THA and certain implant shapes.•Morbidity, mortality and cost impact comparable with native neck of femur fractures. Total joint arthroplasties are increasing worldwide in both frequency and prevalence. When successful, they offer great improvements in quality of life. However, fractures around implants are often difficult to manage and require prolonged inpatient stays in tertiary hospitals. Management may differ between surgeons, but most patients will be managed surgically if mobility or joint stability is threatened. Those affected are often at higher risk from surgery, are frailer and at higher risk of mortality and a lifelong reduction in mobility. The incidence of these fractures is increasing, and patients should appreciate the risk and implications of this recognised complication of joint arthroplasty.