Introduction: Early infection after femoral implant placement is a serious complication influenced by host immunity, wound healing capacity, and nutritional-inflammatory status. Preoperative serum albumin is a practical biomarker that may reflect vulnerability to postoperative infection, but its predictive accuracy remains uncertain in femoral implant surgery. This study aimed to evaluate the sensitivity and specificity of preoperative serum albumin in predicting early infection after femoral implant placement.

Material and methods: This retrospective descriptive cross-sectional study was conducted at Shahid Madani Hospital, Tabriz, on 125 patients selected by convenience sampling. The sample size was estimated using Cochran’s formula. Data were extracted from medical records to evaluate preoperative serum albumin, demographic and clinical variables, operative characteristics, and early postoperative infection after femoral implant placement, with the aim of assessing the diagnostic performance of albumin in predicting early infection.

Results: Among 125 patients, early postoperative infection occurred in 15.2% (19/125). Infected patients had lower preoperative albumin (3.12 ± 0.46 vs 3.66 ± 0.51 g/dL; P < 0.001), a higher rate of hypoalbuminemia (63.2% vs 27.4%; P = 0.002), lower hemoglobin (P = 0.011), and higher inflammatory markers (WBC, P = 0.018; CRP, P = 0.006). Serum albumin predicted infection with good accuracy (cutoff 3.35 g/dL; sensitivity 78.9%, specificity 73.6%, AUC 0.812, P < 0.001).

Conclusion: Preoperative serum albumin appears to be a clinically useful marker for identifying patients at increased risk of early infection after femoral implant placement. Lower albumin levels were consistently associated with infection and showed acceptable diagnostic performance. These findings support incorporating serum albumin into routine preoperative assessment to improve risk stratification and guide perioperative optimization in this surgical population.