Abstract：Objective To explore the clinical effect of hip arthroplasty（HA）in the treatment of femur intertrochanteric fractures in the elderly. Methods A retrospective analysis of 88 elderly with intertrochanteric fractures of the femur who received treatment from January 2017 to March 2020 in our hospital. According to different surgical procedures, the patients who received proximal femoral nail anti-rotation（PFNA）internal fixation were set as the PFNA group, and the patients who received HA were set as the HA group, with 44 cases in each group. The surgical conditions, treatment results and complication rates of the two groups were compared. Results The operation time, intraoperative bleeding, and incision length in the PFNA group were less than those in the HA group, and the time to get out of bed and weight-bearing time were longer than those in the HA group,and the differences were statistically significant between the two groups （t＝8.883, 14.844, 13.089, 18.993, 30.150, all P＜0.05）; while the differences were not statistically significant when comparing the treatment effects of the two groups （χ2＝0.848, P＞0.05）; the incidence of postoperative complications in the HA group was significantly lower than that in the PFNA group, and the difference between the two groups was statistically significant （χ2＝5.091, P＜0.05）.  Conclusion Both HA and PFNA internal fixation for elderly patients with femoral intertrochanteric fractures have good therapeutic effects, and the two methods have their own advantages.