Introduction The prevalence of periprosthetic femoral fractures (PFFs) in Greece has not been previously documented. This study aims to determine the prevalence of PFFs in a Greek population over the past 20 years, using data from a referral centre. Methods A retrospective analysis of PFFs was conducted at a Greek academic orthopaedic department, covering the period from 2004 to 2023. Demographic data, PFF types, treatment methods, time from admission to surgery, length of hospital stay (LOS), and operative times were recorded and compared between the two decades. Results The study included 244 patients with PFFs, with a mean age of 78.2 years. Most patients were female (86.5%, p <
0.001). The incidence of PFFs significantly increased between the first and second decades (mean: 9.8 vs. 14.6 cases per year, p = 0.01). This increase was particularly evident in fractures around total knee arthroplasties (TKAs) (p = 0.0027). Treatment choices between internal fixation and revision arthroplasty remained consistent over time for PFFs around total hip arthroplasties (THAs) and TKAs (p >
0.05). However, the LOS and the time from admission to surgery significantly decreased from the first to the second decade (p = 0.001 and p = 0.02), respectively. Conclusion This study is the first to document PFFs in a Greek population, showing a notable increase in incidence, higher prevalence among females, consistent treatment methods, and a reduction in the time from admission to surgery and LOS over the past decade.