Abstract Periprosthetic fractures of the femur are a challenging complication following total joint arthroplasty. They can occur in either the perioperative or postoperative periods and although they are separate entities, the principles on which management decisions are based remain the same. The Vancouver classification system is becoming the most widely accepted for fractures following total hip arthroplasty and that of Lewis and Rorabeck following total knee arthroplasty, although treatment cannot be based on any one classification system alone. The aim is to achieve fracture union around a stable, well-aligned arthroplasty with preserved or restored bone stock and therefore return the patient to their previous level of function. We describe our approach to the management of perioperative and postoperative femoral fractures associated with total joint arthroplasty.