Abstract： Objective： To observe the effect of modified Duhuo Jisheng Decoction combined with total hip arthroplasty on bone metabolism indicators and hemodynamics in elderly patients with hip fractures. Methods：A total of 122 elderly patients with hip fractures admitted to Yuyao Hospital of Traditional Chinese Medicine from January 2023 to December 2024 were selected and divided into the observation group and the control group according to the random number table method， with 61 cases in each group. The control group was given total hip arthroplasty and postoperative conventional management， and the observation group was additionally given modified Duhuo Jisheng Decoction based on the treatment in the control group. The changes in bone metabolism indicators [serum bone alkaline phosphatase （BALP）， osteocalcin （BGP） and C-terminal telopeptide （CTX-1） of type I collagen]， hemodynamic parameters [whole blood high-shear/low-shear reduced viscosity and erythrocyte aggregation index]，venous parameters [common femoral vein，superficial femoral vein and deep femoral vein]，coagulation function [prothrombin time （PT）， activated partial thromboplastin time （APTT） and thrombin time （TT）] and scores of Visual Analogue Scale （VAS） of pain before and seven days after surgery，and the incidence of adverse reactions and deep venous thrombosis （DVT） of lower extremity after one month of follow-up were compared between the two groups. Results：Seven days after surgery， the levels of BALP and BGP in the two groups were increased when compared with those before surgery （P＜0.05），and the levels of CTX-1 were decreased when compared with those before surgery （P＜0.05）. The levels of BALP and BGP in the observation group were higher than those in the control group，and the level of CTX-1 was lower than that in the control group （P＜0.05）. Seven days after surgery，the whole blood high-shear and low-shear reduced viscosity in the two groups were decreased when compared with those before surgery （P＜0.05），and the erythrocyte aggregation index， blood flow parameters of common femoral vein， superficial femoral vein and deep femoral vein were increased when compared with those before surgery （P＜0.05）； the whole blood high-shear and low shear reduced viscosity in the observation group were lower than those in the control group （P＜0.05），and the blood flow parameters of the common femoral vein， superficial femoral vein and deep femoral vein were higher than those in the control group （P＜0.05）. Seven days after surgery， TT， PT and APTT in the two groups were prolonged when compared with those before surgery（P＜0.05），and TT，PT and APTT in the observation group were longer than those in the control group （P＜ 0.05）. Seven days after surgery， the VAS scores in the two groups were decreased when compared with those before surgery（ P＜0.05），and the VAS score in the observation group was lower than that in the control group（ P＜0.05）. The incidence of DVT in the observation group was lower than that in the control group （P＜0.05）；there was no significant difference being found in the comparison of the incidence of adverse reactions between the two groups （P＞0.05）. Conclusion： The therapy of modified Duhuo Jisheng Decoction combined with total hip arthroplasty can improve the coagulation function and hemodynamics of elderly patients with hip fractures，prevent DVT，mitigate pain and promote the bone metabolism with great safety.