Aims Periprosthetic femoral fracture is a severe complication following hip arthroplasty, influenced by the design of the femoral component and the method of fixation. The aim of this study was to investigate the influence of sex and age on the risk of reoperation for periprosthetic femoral fracture. Methods We analyzed 204,041 primary hip arthroplasties from the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register (1 January 2005 to 31 December 2025). Femoral components were categorized as cemented composite beam (CB), cemented polished taper-slip (PTS), uncemented collarless (UCC-), and uncemented collared (UCC+). Cox regression analysis was used to compare the risk (adjusted hazard rate ratio (aHRR)) of reoperation for periprosthetic femoral fracture stratified by sex and age. Results In males, PTS and UCC- had a nine-times higher risk of reoperation for periprosthetic femoral fracture than CB. For UCC+, the risk was four times higher than CB. The risk of reoperation for periprosthetic femoral fracture was increased in males aged > 65 years for UCC-; for UCC+ the risk was increased in males aged > 75 years, whereas PTS had higher risk for periprosthetic femoral fracture at all ages, compared with CB. In females, the risk of reoperation for periprosthetic femoral fracture was increased in those aged > 70 years for PTS and UCC+ compared with CB, whereas for UCC- the risk of periprosthetic femoral fracture was higher in those aged > 60 years, compared with CB. Conclusion Our findings suggest that CB should be the preferred choice of femoral component, at least for males aged > 75 years and females aged > 70 years. UCC+ components were the best uncemented option, while the use of PTS components was associated with a high risk of periprosthetic femoral fracture among males of all ages.
