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Periprosthetic femoral fractures (PFF) are among the more difficult and expensive complications of total hip arthroplasty. A rise in the elderly population and increase use of primary hip replacement has led to an escalating incidence. They can occur intra operatively and post operatively. The treatment algorithm defined by the Vancouver classification has universal acceptance. The epidemiology, etiology, classification and the management of periprosthetic femoral fractures in total hip arthroplasty are reviewed.