Abstract Objective To investigate the influencing factors and prognosis of hypoxemia after artificial joint replacement, so as to provide help for correct diagnosis and treatment. Methods The clinical data of 21 patients with hypoxemia after artificial joint replacement in our hospital from January 2016 to April 2020 were retrospectively analyzed, and the control study was conducted with joint replacement patients in the same period. The differences of gender, age, height, body mass index, operation type, operation time, perioperative dominant and invisible blood loss, hemoglobin and red blood cell decline, and perioperative SpO2 were observed. Results ① SpO2 level decreased in both groups after operation, and the decrease range on operation day was 4.12% in the observation group and 2.06% in the control group, there were significant differences compared with the preoperative level of SpO2 (t control group = 4.184, t observation group = 5.448, P < 0.001). ② There was no significant difference in SpO2 on the third day after operation in the control group (t = 0.908, P = 0.366) ,But in the observation group was not significantly improved, and the difference was statistically significant compared with the control group (P < 0.001).③ There were significant differences in age, BMI index, ASA grade and operation type in the two groups (P < 0.05). There was no significant difference in gender, operation time, dominant blood loss, invisible blood loss, △Hg and △RCB (P > 0.05). Conclusions The incidence rate of hypoxemia after joint replacement was high, early detection and intervention should be timely.