Aims: The pourpose of this study is to review a series of A2 intertrochanteric fractures in old, obese osteoporotic patients treated by total hip arthroplasty. Methods: 52 patients with A2 intertrochanteric fracture aged ≥ 75 years, mentally healthy, with BMD lower than 2.5 T score and Body Mass Index ≥30 were selected. They were 40 female and 12 males, aged 82±5 years with Body Mass Index of 32±2. Through a Hardinge approach to the hip, the femoral head was removed and a cemented cup and stem were implanted. Then the greater trochanter fragments were fixed by cerclage. The lesser trochanter fragment was not fixed. Medius gluteus muscle fibers were sutured to the greater trochanter and to the vastus lateralis muscle. All patients were allowed weight bearing as soon as possible after surgery. Results: No surgical complications were observed. Average Harris Hip Score at 1 month was 63±9 at 3 months 77±6 and at 1 year 78±7, at 5 years follow up 76±14 in the 24 patients still alive. None of the other died for causes related to the interthrocanteric fracture. Average return to normal daily activity time was 27±5 days. Conclusions: Total hip arthroplasty is a safe procedure for treatment of old, obese osteoporotic patients affected by A2 intertro-chanteric fractures. In fact, no failure occurred in any of the patients allowed unrestricted weight bearing from the first day after surgery. Moreover, they could return to normal daily activity in less than 5 weeks.