The long-stem, long-neck endoprosthesis is used in the treatment of pertrochanteric hip fractures in the elderly. Between 1978 and 1984, 157 patients 70 years of age and over were treated at our clinic for fresh unstable pertrochanteric hip fractures. Fifty-five patients had internal fixation. Because of the high incidence of mechanical complications, the long spherostem endoprosthesis became the treatment of choice between 1980 and 1984. Thus, 102 patients were treated with this type of arthroplasty. They were compared with the 55 patients treated with osteosynthesis, and we concluded that: (1) in comparison with osteosynthesis, the procedure of endoprosthetic replacement is no more extensive and the mortality is no higher; (2) the incidence of mechanical complications is significantly lower in the endoprosthesis group; (3) even if the dynamic hip screw is now the treatment of choice for pertrochanteric fractures, the long spherostem endoprosthesis is still indicated in arthrotic hip fractures or in the case of reintervention after implant failure.