From January 1997 to August 1998 all stable and nonstable trochanteric femoral fractures (n = 72) were treated routinely by gamma nail using the correct operative technique. Patients showing additional osteoarthritis of the hip in radiographs hip replacement was performed by a cementless modular femoral hip prostheses from January 1996 to August 1998 (n = 28). Follow up period was 6 to 18 months. Operation time and blood loss were higher using the prostheses. However complications and lethality (< 5%) were not different during postoperative course. In each group three operative technical complications occurred. Using a modified Harris Hip Score (without range of motion, contractions) the score was decreased non significant comparing both groups first of all in unstable fractures until follow up. In each group one revision (loosening of prostheses, excessive shortening of femoral neck) was necessary. Using the correct operative technique, the gamma nail proved to be a save device with good outcome. Outcome using modular prostheses is comparable to gamma nail. Therefore the use of modular prostheses is justified in case of osteoarthrosis and in some cases of very unstable fracture.