Introduction: Surgical site infections following femoral implant placement cause severe morbidity, often driven by host malnutrition and baseline inflammation. Serum albumin and C-reactive protein (CRP) reflect metabolic reserve and systemic inflammatory tone, respectively. Therefore, this study aimed to compare preoperative serum albumin and CRP levels in relation to surgical site infection incidence following femoral implant placement.

Material and methods: This analytical cross-sectional study enrolled 125 consecutive patients undergoing primary femoral implant surgery at shohada Hospital, Tabriz. Baseline preoperative serum albumin and C-reactive protein concentrations were quantified alongside comprehensive clinical and operative variables. Patients underwent systematic surveillance over a 90-day postoperative period to adjudicate surgical site infections based on CDC/NHSN criteria, evaluating biomarker predictive performance through comparative and multivariable regression analyses.

Results: Patients developing surgical site infections demonstrated significantly reduced preoperative serum albumin (3.12±0.46 versus 3.89±0.49 g/dL; P<0.001) and elevated hs-CRP concentrations (20.38±6.84 versus 7.31±4.58 mg/L; P<0.001). Multivariable logistic regression identified preoperative hypoalbuminemia (aOR=7.845, 95% CI: 1.614 to 38.128; P=0.011), elevated hs-CRP (aOR=9.132, 95% CI:1.684 to 49.524; P=0.010), low albumin-to-CRP ratio (aOR=11.418, 95% CI: 1.925 to 67.726; P=0.007), and prolonged operative duration (aOR=4.892; P=0.044) as independent infection predictors.

Conclusion: Preoperative hypoalbuminemia and elevated C-reactive protein levels are potent independent predictors of postoperative surgical site infections following femoral hardware fixation. Preoperative screening with these cost-effective biomarkers, particularly the composite albumin-to-CRP ratio, facilitates early risk stratification and enables targeted nutritional and anti-inflammatory interventions to mitigate implant infection rates.