Failed treatment of an intertrochanteric fracture typically leads toprofound functional disability and pain. Treatment with repeatedattempts to gain union and to preserve the host femoral head usually ispreferred for young patients, but salvage treatment with hip arthroplastymay be considered for selected older patients with poor bone quality,bone loss, or articular cartilage damage.In the elderly patients, arthroplasty has some advantages; fracturefixation does not need to be considered, the biomechanics of the hip canbe more readily restored, and the patients can be mobilized quicklywithout the need for external supports for long periods. Many patientsdemonstrated clinically significant pain relief and return to ambulationfollowing bipolar hemiarthroplasty or total hip arthroplasty usingmodular proximal femoral replacements with long stem prosthesis tobypass the stress risers and the weak proximal bone. A calcar-replacingstem is needed but may be used when the medial cortex is absent. Earlierintervention after failed trochanteric internal fixation should berecommended so that prolonged disability could be avoided.Despite the operative challenges, surprisingly few seriousorthopaedic complications and many specific problems may occur. Thesurgery takes longer because the internal fixation device first must beremoved. The blood loss is increased because the surgeon must dissectthrough the old scar to expose the internal fixation device. The anatomyof the proximal femur usually is distorted, especially if the reduction ofthe intertrochanteric fracture is imperfect, or if there is comminution ofthe medial bony buttress. The bone quality usually is poor as a result ofpre-existing osteoporosis, which further decreases as a result of disuseafter the failure of internal fixation. The greater trochanter either is notsolidly healed or can be fragmented again during the hip arthroplasty,thus affecting the abduction function, which leads to an increaseddislocation rate and can adversely affect the ambulatory function afterthe hip arthroplasty.