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A periprosthetic femoral fracture around a hip hemiarthroplasty represents a complexmanagement problem. Patients are often elderly with multiple comorbidities. There is littlepublished data regarding the outcomes of this cohort of patients.Between 1999 and 2009, 3,246 patients with intracapsular hip fractures were treated at Queen'sMedical Centre, Nottingham, a large United Kingdom teaching hospital, withhip hemiarthroplasty. During this time period, 57 patients (incidence 1.8%) were treated for apost-operative periprosthetic fracture around the hip hemiarthroplasty.Prospective data was collected on all patients by audit officers at time of periprosthetic fracture.Hospital notes were independently reviewed and data retrieved using a standardised proforma torecord the treatment of the fracture and all subsequent, related admissions for further treatmentand complications.Patient outcomes were determined according to fracture union, death and loss of follow-up.Failure was defined as fracture non-union and/or requirement for further revision surgery.The mean age was 84 years. 72% were female. The mean time from hip fracture surgery toperiprosthetic fracture was 35 months (0-420). 33% of patients sustained their fracture within 1month of their hip fracture surgery. 44 (77%) occurred around uncemented prostheses (AustinMoore n=43; Thompson n=1). 13 occurred around cemented prostheses (Hastings n=8; Exeterstems n=3; Thompson n=2). Mean length of hospital stay was 35 days (7-88).Vancouver classification was as follows: (n=15), B2 (n=18), B3 (n=5) and C (n=4). Theremainder were type A fractures, one of which was treated operatively. 47 (82%) underwentsurgical fixation or revision. 21 patients underwent fixation and 27 underwent revision. In thoserevised, bipolar heads were used in 22 cases (74%).The mean time to fracture union was 3.8 months. 12 patients died before union. Furtherrevision surgery was performed in three patients (5%; two for infection, one for loosening).Deep infection occurred in three patients (5%). Wound washout was performed for three furtherpatients to treat superficial infection. No patients developed non-union or dislocation.Mortality rate was 9% within one month of periprosthetic fracture, 32% within 1 year and 59%within 3 years. Mortality rates have been compared with mortality rate at our institution afterhip fracture, which reveals similar mortality rates (Figure 1).15 patients are still alive with amean follow up of 65 months; none lost to follow-up.Pre-fracture confusional state increased risk of mortality at 3 months (p=0.05), 1 year (p=0.04)and 2 years (p=0.03) (Fisher’s exact test). Living in institutional care prior to periprostheticfracture increased the risk of mortality at 1 year (p=0.02) and 2 years (p=0.01). Post-operativemedical complications also increased the risk of mortality at 3 months (p