Objective To explore the risk factors related to preoperative frailty in elderly patients undergoing major orthopedic surge-ry, to develop a risk assessment model and test its predictive validity. Methods A total of 384 elderly patients scheduled for major orthopedic surgery were investigated using a self-designed general information questionnaire, the FRAIL scale, Charlson Comorbidity Index, Exercise Tolerance Evaluation,Geriatric Depression Scale-15 and Short-form Mini-Nutritional Assessment.Then logistic regression analysis was employed to determine the risk factors, and the receiver operating characteristic (ROC) curve was used to test the model. Results The prevalence of preoperative frailty was 50.5% in elderly patients undergoing major orthopedic surgery. The risk factors included age greater than 80, memory loss and social activity reduction, malnutrition and presence of comorbidity. The area under the ROC curve of this model was 0.727, with the Youden index of 0.422, the sensitivity of 0.722, and specificity of 0.700. Conclusion Preoperative frailty was common in elderly patients undergoing major orthopedic surgery；advanced age, memory loss and social activity reduction, malnutrition and comorbidity were risk factors. The predictive validity of the model was satisfactory, but large samples are required to validate the model.