Arthroplasty of major joints ranks among the most common and successful orthopaedic procedures performed globally, as reflected in joint registry data. This trend, combined with longer life expectancy and a higher prevalence of comorbidities like osteoporosis, has contributed to a rising incidence of femoral periprosthetic fractures (PPFs) [1] Their incidence is projected to double in the next two decades as arthroplasty demand rises [[2], [3], [4]]. The presence of an arthroplasty component complicates or precludes standard fixation methods, a challenge further intensified by the frequent occurrence of these fractures in elderly patients with osteoporotic bone [5]. PPFs, which predominantly affect older patients with multiple comorbidities, are linked to serious medical complications, extended hospitalizations, and delayed recovery which contribute to high inpatient mortality [6]. One year mortality following PPF approaches that of native hip fracture, with large series reporting rates of 22–27 % [[7], [8], [9], [10]]. This has been related, in part, to a lack of geriatric co-management, an optimisation based approach with individualisation of surgical management has been suggested to enhance functional outcomes whilst reducing economic burdens [7].

Historically, optimal outcomes have been reported from tertiary, high-volume centres [11,12]. Yet most PFFs present to district general hospitals, where limited resources create the risk of delayed surgery, suboptimal decision-making, and institutionalization [13,14].

The fixation versus revision debate continues. Meta-analyses and multicentre studies confirm higher reoperation rates with fixation in unstable patterns, while revision arthroplasty provides more durable outcomes [[13], [14], [15], [16], [17]].

Globally, there is increasing recognition that system-level strategies such as multidisciplinary team (MDT) pathways, orthogeriatric optimisation, and enhanced recovery protocols — are critical determinants of outcomes [7,18]. Yet, evidence from district hospitals is sparse. Our study evaluates whether a dedicated weekly periprosthetic list with MDT involvement can deliver results comparable to those of large-volume centres.