Objective To compare the recessive and dominant blood loss and total blood loss during the perioperative period between proximal femoral nail antirotation(PFNA)and artificial femoral head replacement in the treatment of Evans Ⅲ,Ⅳ type femoral intertrochanteric fractures for providing clinical evidence on selection of operative methods. Methods A retrospective study was conducted to analyze 61 older hospitalized patients with Evans Ⅲ,Ⅳ type femoral intertrochanteric fractures in Jimo City Traditional Chinese Medical Hospital from January 2009 to September 2014.The PFNA was adopted in 33 cases and the artificial femoral head replacement in 28 cases.The dominant blood loss was recorded,and total blood loss and recessive blood loss in the two groups were calculated by Gross equation according to the dominant blood loss,body height,body weight and hematocrit of pre-and post-operation. Results The average dominant blood loss in the intraoperative period was much less in the PFNA fixation group(106.2 ± 53.8)ml than in the artificial femoral head replacement group(274.6 ± 80.3)ml(P<0.05).The average recessive blood loss in the perioperative period was much less in artificial femoral head replacement group(577.0 ± 52.2)ml than in PFNA group(821.8 ± 69.5)ml(P<0.001).The total blood loss during the perioperative period was not significantly different between proximal femoral nail antirotation(896.0 ± 227.5)ml and artificial femoral head replacement(908.6 ± 204)ml(P>0.05). Conclusions There is obvious difference in the dominant blood loss between PFNA and artificial femoral head replacement for treatment of Evans Ⅲ,Ⅳ type femoral intertrochanteric fractures in the elderly patients.The proper operative method should be chosen based on the general condition of the elderly and fracture types.