Periprosthetic fractures in total hip and total knee arthroplasty lead to considerable morbidity in terms of component fixation, bone loss, and subsequent function. The management of these fractures is technically demanding and may result in suboptimal fixation owing to poor bone stock. The prevention, early recognition, and appropriate management of such fractures are therefore critical. The pathogenesis of periprosthetic factors is multifactorial. There are a number of intrinsic patient influences such as bone stock, biomechanics, and compliance. There are also a host of extrinsic factors over which the surgeon has more control. The prevention of periprosthetic fractures requires careful preoperative planning and templating, the availability of the necessary expertise and equipment, and knowledge of the potential pitfalls so that these can be avoided both intraoperatively and in follow-up.