Perioperative management of the patient for total joint surgery involves a basic understanding of the patient’s preexisting conditions, the surgical plan, and the potential for intraoperative complications. This patient population often presents with multiple comorbidities, in addition to degenerative joint disease, which can complicate the perioperative course. Proper preoperative workup and intraoperative monitoring are paramount in reducing morbidity and mortality. Choice of anesthetic technique (Regional vs. General) should not only take into consideration preexisting conditions, but also length or surgery, risk of nerve injury, and potential for blood loss. The most common complication to occur during joint replacement surgery is acute blood loss, followed by venothromboembolism. Although the incidence of these events is relatively low, given the new advances in anesthetic and surgical techniques, it is important to recognize in the setting of intraoperative hypotension. Postoperative management of the orthopedic patient includes adequate analgesia with multimodal techniques utilizing both pharmacologic methods and regional anesthetic techniques with the aim of facilitating early ambulation.