Abstract: [Objective] To explore the clinical effect of different biotypes of femoral prosthetic stem artificial hip arthroplasty in the treatment of elderly unstable intertrochanteric fractures.[Methods] a retrospective analysis was conducted on the data of 61 elderly patients (62 hips) with intertrochanteric fracture treated by hip replacement with different biological femoral prosthesis stitium from July 2017 to December 2018, including 25 males and 36 females. The age ranged from 73 to 94 years, with an average age of (78.35±3.86) years.The fractures were classified by Evans-Jensen: 9 cases of type III, 33 cases of type IV, and 19 cases of type V. All cases were associated with osteoporosis of different degrees, and were classified according to the Singh index: 48 cases of grade III and 13 cases of grade II.The operative time, intraoperative blood loss, postoperative partial load time, postoperative full load time, thigh pain, postoperative patient satisfaction, mortality and postoperative complications were observed.36 cases of conventional femoral prosthesis, 17 cases (18 hips) of extended biological femoral prosthesis and 8 cases (18 hips) of columnar thick Wagner femoral prosthesis were treated with hip replacement. In this group, 49 cases (50 hips) of double-acting femoral head replacement and 12 cases of total hip replacement were performed.Postoperative X-ray was followed up regularly to observe the position of the prosthesis, Engh standard was used to evaluate the bone-prosthesis interface stability, and Harris score was used to evaluate hip joint function. Harris score of hip joint function was compared before surgery, 6 months after surgery and 12 months after surgery.[Results] 61 patients (62 hips) were followed up for 12-28 months, with an average (16.52 ± 1.28) months of follow-up. The operation time in this group was 43-85 minutes, with an average of (55.48 ± 10.61) minutes; the intraoperative blood loss was 200-550 mL, with an average of (310.54 ± 30.56) mL.Two patients developed pulmonary infection in the early postoperative stage and recovered after anti-infection treatment. Three patients had thigh pain. The postoperative partial loading time was (4.82±0.58) d, and the postoperative complete loading time was (56.71±6.86) d.Postoperative patient satisfaction was good.During the follow-up period, there were no complications such as prosthesis loosening, fracture, infection, joint instability, dislocation, death and vascular and nerve injury.All 61 patients (62 hips) achieved the biological compression of femoral prosthesis stalk after surgery, and the fixation effect of femoral prosthesis stalk was evaluated as good according to Engh fixation/stabilization standard 6 months after surgery, and all patients had stable bone ingrowth.The Harris score of hip joint function was (28.65 ± 4.25) before surgery, (84.28 ± 3.83) after 6 months, and increased to (88.43 ± 3.52) at the last follow-up. The difference was statistically significant (t = 21.512, P < 0.001).[Conclusion] For elderly unstable intertrochanteric fractures that are difficult to reduce with severe osteoporosis at the same time and difficult to maintain stability after reduction, choose according to the shape of the proximal femoral medullary cavity, the quality of the bone, and the scope of the fracture. Different types of femoral prosthesis handles undergoing artificial hip joint replacement can promote hip joint function recovery and obtain good clinical effects.