OBJECTIVE As the number of total hip arthroplasties (THAs) is increasing, the expected number of periprosthetic femur fractures is also expected to increase. As such, a thorough grasp of the evaluation and management of patients with periprosthetic femur fractures is imperative, and discussed in this review. METHODS This review discusses the epidemiology, classification, and management of periprosthetic femur fractures in an evidence-based fashion. RESULTS Periprosthetic fracture management starts with assessing stem stability and bone quality. Well-fixed stems require fracture fixation without stem revision, while loose stems require revision THA. CONCLUSIONS Periprosthetic femoral fractures after primary total hip arthroplasty are a complex and clinically challenging issue. The treatment must be based on the fracture, the prosthesis, and the patient (Table 1). The Vancouver classification is not only helpful in classifying the fractures, but also in guiding the treatment. In general, well-fixed stems require open reduction and internal fixation, whereas loose stems require revision arthroplasty.