Objective: To analyze the effect of sevoflurane inhalation combined with intravenous anesthesia in elderly patients with total hip replacement. Methods: From April 2021 to June 2024, 70 elderly patients who were to undergo total hip replacement were selected as the study objects. Patients were divided into control group and observation group by random number table method, with 35 cases in each group. The control group received intravenous anesthesia; Observation group received sevoflurane inhalation combined intravenous anesthesia. The recovery from anesthesia, heart rate (HR) and mean arterial pressure (MAP) at entry (T0), 5min after induction of anesthesia (T1), intubation (T2), after surgery (T3) and extubation (T4), and adverse reactions were analyzed and compared between the two groups. Results: The postoperative eye opening time, swallowing time and extubation time of observation group were significantly shortened compared with control group (P < 0.05). HR and MAP were significantly decreased at T1 to T4 in both groups compared with T0 (P < 0.05), and were stable at T1 to T4 in the observation group (P > 0.05). In control group, HR and MAP at T2 were significantly increased compared with T1, HR and MAP at T3 were significantly decreased compared with T2, and HR and MAP at T4 were significantly increased compared with T3 (P < 0.05). HR and MAP of observation group at T1 and T3 were significantly higher than those of control group, and HR and MAP at T2 were significantly lower than those of control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion: Sevoflurane inhalation combined with intravenous anesthesia can promote anesthesia recovery, reduce hemodynamic fluctuations, and have high safety.