The incidence of ipsilateral fracture of the lower extremity after total hip replacement (THR) was evaluated in 1442 THRs performed between 1968 and 1983. Twenty-two fractures had occurred, of which 14 were femoral. Twelve of the femoral fractures occurred in women and two in men. The accumulated postoperative risk of femoral fracture during an observation period of 15 years was 25.3 per 1000. Short femoral stems were associated with proximal femoral fractures and long stems with more distal femoral fractures. No specific preoperative diagnosis such as arthrosis, rheumatoid arthritis, or femoral neck fracture was associated with significantly increased incidence of postoperative fractures.