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BACKGROUND: Digital three-dimensional reconstruction technology is gradually applied to orthopedic diseases with the advantages of visualization, accuracy and non-invasiveness, but there is less evidence-based support for its use in artificial hip hemiarthroplasty for intertrochanteric fractures of the femur in the elderly. OBJECTIVE: To investigate the application value and economic effects of digital three-dimensional reconstruction techniques in artificial hip hemiarthroplasty of intertrochanteric fractures of the femur in the elderly. METHODS: One hundred and thirty elderly patients with intertrochanteric femur fractures admitted to Zunyi First People’s Hospital from January 2019 to December 2022 were selected and randomly divided into a control group (n=65) and an observation group (n=65). Artificial hip hemiarthroplasty was performed in both groups. The control group adopted the film template measurement method for manual preoperative planning while the observation group adopted a digital three-dimensional reconstruction technique. Preoperative planning and intraoperative actual application of prosthesis compliance rate, fibrinogen, D-dimer, bilateral femoral eccentric distance difference, bilateral lower limb length difference, Harris hip function score, visual analog scale score, excellent and good rate of hip function, complications, and hospitalization cost were observed in both groups. RESULTS AND CONCLUSION: (1) The proportion of acetabular side and femoral side prosthesis in grade 0 (fully compliant) was higher in the observation group than that in the control group (P < 0.05). (2) Fibrinogen and D-dimer levels in the observation group were lower than those in the control group 3 days after surgery (P < 0.05). (3) The difference in bilateral femoral eccentric distance and the difference in bilateral lower limb length in the observation group were smaller than those in the control group immediately after surgery (P<0.05). The differences in Harris and visual analog scale scores were not significantly different between the two groups preoperatively, 6 and 12 months postoperatively (P > 0.05). There was no significant difference in excellent and good rate of hip function between the two groups 12 months postoperatively (P>0.05). (4) There was no significant difference in the complication rate between the two groups (P > 0.05). The hospitalization cost of the observation group was higher than that of the control group (P<0.05). (5) It is indicated that digital threedimensional reconstruction technology applied in artificial hip hemiarthroplasty of intertrochanteric femoral fracture in the elderly can not only accurately determine the prosthesis type before surgery, but also accurately reconstruct the bilateral lower limbs offline, but its hospitalization cost is high. [ABSTRACT FROM AUTHOR]