Objective To investigate the clinical effect of three kinds of surgeries in the treatment of femoral intertrochanteric fractures in the elderly and the influence on the recovery of hip function. Methods The medical data of 110 elderly patients with femoral intertrochanteric fractures who were treated in the hospital from January 2015 to December 2018were analyzed retrospectively. According to the surgical method, the patients were divided into the proximal femoral locking compression plates group (PFLCP group, 37 cases), proximal femoral nail antirotation group (PFNA group, 41 cases) and joint replacement group (32 cases). The surgical time, the length of incision, intraoperative blood loss, postoperative drainage volume, the hip Harris score and the incidence of postoperative complications were compared between the three groups. Results The surgical time, length of incision, intraoperative blood loss and postoperative drainage volume of PFLCP group and joint replacement group were longer / more than those of PFNA group (P ＜ 0.05),without significant difference between PFLCP group and joint replacement group (P ＞ 0.05). The full weight-bearing time showed the joint replacement group ＜ PFNA group ＜ PFLCP group (P ＜ 0.05). Harris scores of PFLCP group and PFNA group at 1 month and 3 months after surgery were lower than those of the joint replacement group (P ＜ 0.05), without statistically significant difference between PFLCP group and PFNA group (P ＞ 0.05). There was no significant difference among the three groups in the Harris scores at the end of follow-up (P ＞ 0.05). The excellent and good rates of Harris scores of the three groups at the end of follow-up were 83.78%, 90.24% and 93.75%, respectively (P ＞ 0.05). The incidence rates of complications in the three groups were 5.41%, 7.32% and 9.38%, respectively (P ＞ 0.05). Conclusion The long-term hip function recovery in elderly patients with femoral intertrochanteric fractures treated by PFLCP, PFNA and artificial joint replacement is basically the same. The three surgical options have their own advantages and disadvantages in clinical practice.