A retrospective study analyzed 141 cases of failure of internal fixation of peritrochanteric femoral fractures in patients with a mean age of 60.34 ± 16.02 years (73 women), including 96 intertrochanteric (AO/OTA A1–A3) and 45 subtrochanteric (Seinheimer) fractures from 2013–2023. They classified failures into four groups according to age, infection, integrity of the femoral head, acetabulum, varus deformity, and implant status, with tailored revision procedures. The average follow-up time was 15.96 ± 5.61 months, the length of revision surgery 143.06 ± 57.29 min (shorter for joint replacement: 107.50 ± 41.40 min, P < 0.01) and intraoperative blood loss 344.26 ± 335.43 ml. The joint replacement group had an older age (72.13 ± 13.00 years, P < 0.05) and less blood loss (P < 0.01). The duration of healing was 7.08 ± 3.33 months, the Harris hip score improved from 24.78 ± 6.08 to 80.59 ± 4.54, but patients in group IV had a lower score (P < 0.05). Imaging and functional outcomes were favorable when protocols were followed.