Periprosthetic fractures of the femur are increasing both in the absolute number of fractures per year and in frequency (proportion of fractures among patients with hip arthroplasty). As a result, orthopaedic surgeons will face these challenging injuries more often. The optimal treatment must be individualized, taking into consideration the fracture location relative to the arthroplasty component, the implant stability, the underlying quality of the bone, and the medical and functional status of the patient. Based on these factors, successful treatment usually involves some combination of open reduction, internal fixation, and revision arthroplasty with or without adjuvant bone grafting.