Objective: To analyze the effects of propofol through closed-loop target-controlled infusion (TCI) on cardiovascular stress response in elderly patients undergoing hip arthroplasty. Methods: A total of 240 elderly patients who underwent hip replacement in our hospital from August 2019 to August 2020 were selected. Patients enrolled from August 2019 to February 2020 were assigned into group A (n=114, propofol using closed-loop TCI) and patients enrolled from March 2020 to August 2020 were assigned into group B (n=126, propofol by manual infusion). The perioperative related indexes, pain score [Visual Analog Scale (VAS)], cardiovascular stress response [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR)], inflammatory response [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] and postoperative complications were compared between the two groups. Results: There were no significant differences in operation time and intraoperative blood loss between the two groups (P>0.05). The amount of propofol, recovery time, and extubation time in group A were significantly less than those in group B (P<0.05). VAS score was significantly lower than that of group B (P<0.05). At different times, the changes in DBP, SBP and HR in group A were smaller than those in group B (P<0.05). The changes in IL-6 and TNF-α levels in group A were smaller than those in group B at different times (P<0.05). The total incidence of complications in group A was significantly lower than that in group B Group (4.39% vs 12.70%, P<0.05). Conclusion: For elderly patients undergoing hip replacement, the propofol via closed-loop TCI anesthesia can reduce the dosage of propofol, accelerate the postoperative recovery of patients, and reduce the stress and inflammation caused by surgery, with fewer complications.