Periprosthetic fracture with preexisting severe loss of bone stock is a challenging condition to treat. Available surgical options can be divided into three categories: complex reconstruction of the deficient proximal femur with secure distal fixation; segmental substitution of the proximal femur with a megaprosthesis or allograft/stem composite; and distally fixed replacement with a modular stem, which acts as a scaffold around which the remaining deficient proximal bone can be assembled, to unite and possibly reconstitute.