Objective: To investigate the clinical value of hemihip replacement (HA) and proximal anti-rotation intramedullary nail (PFNA) in the treatment of intertrochanteric fracture (IFF). Methods: The clinical data of 80 patients with IFF admitted to our hospital from May 2022 to May 2024 were retrospectively collected. Patients were divided into HA group (hemi hip replacement, 38 cases) and PFNA group (proximal femoral antirotation nailing, 42 cases) according to different surgical methods. Surgical indicators, pain degree (NRS score), hip function (Harris score) and complications were collected and compared between the two groups. Results: Compared with HA group, incision length, operation duration, hospital stay and intraoperative blood loss were significantly reduced in PFNA group, and postoperative weight-bearing time was significantly extended (P < 0.05). On day 1, day 3 and day 7 after surgery, the NRS scores of both groups were significantly lower than those before surgery, and with the extension of postoperative time, the NRS scores of both groups were significantly reduced. The NRS score of PFNA group was significantly lower than that of HA group on day 1, day 3 and day 7 after operation (P < 0.05). At 1 month, 3 months and 6 months after surgery, the Harris scores of both groups were significantly higher than those before surgery, and with the extension of postoperative time, the Harris scores of both groups were significantly improved. The Harris score of PFNA group was significantly higher than that of HA group at 1, 3 and 6 months after operation (P < 0.05). There was no significant difference in the total complication rate between the two groups (P > 0.05). Conclusion: Compared with HA, PFNA in the treatment of IFF patients can shorten operation time, reduce intraoperative blood loss, relieve pain, prolong postoperative weight-bearing time, and promote postoperative recovery, with high safety. But it has poor effect on hip function recovery.