Periprosthetic femoral fractures can be a difficult management problem. Proximal femoral fractures with a loose component are managed best with revision arthroplasty. We reviewed the midterm follow-up of 14 proximal femoral fractures managed with a long-stem extensively porous-coated femoral component. The average follow-up in this series was 8.2 years (minimum, 5.3 years). Fractures were treated with open reduction and internal fixation, supplemental cortical strut grafting when required, and a canal-filling implant. All fractures achieved union with an average time to union of 4 months. There have been no component failures requiring revision. Twelve prostheses achieved stable bone ingrowth, 1 component showed stable fibrous ingrowth, and 1 component was not stable but was not symptomatic enough to warrant revision.