〔Abstract〕 Objective To investigate the effect of dexmedetomidine anesthesia induction on serum C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) levels in elderly patients undergoing total hip replacement. Methods A total of 100 elderly patients with artificial hip replacement admitted the First People's Hospital of Shaoguan from February 2020 to February 2022 were selected. According to the induction anesthesia method, they were divided into an observation group (induced by dexmedetomidine) and a control group (induced by midazolam), with 50 cases in each group. The vital signs, inflammatory response, degree of sedation, occurrence of restlessness during the recovery period, and occurrence of adverse reactions were compared between the two groups. Results The mean arterial pressure (MAP) and heart rate (HR) of the observation group were lower than those of the control group before anesthesia (T0), operation timing (T1), immediately after the operation (T2), and 6 h after the completion of surgery (T3), and the differences were statistically significant (P < 0.05). The levels of CRP and TNF-α at T1, T2 and T3 in the observation group were lower than those in the control group, and the differences were statistically significant (P < 0.05). The Ramsay sedation score of the observation group at T3 was higher than that of the control group, and the difference was statistically significant (P < 0.05). The incidence of restlessness in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). The incidence of adverse reactions in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion Compared with 0.9 % sodium chloride anesthesia induction, dexmedetomidine anesthesia induction can reduce serum CRP and TNF-α levels in elderly patients undergoing artificial hip replacement.