28 studies (21 RCTs, 2 prospective comparative, 2 case-control, 3 retrospective comparative) were included in this systematic review to determine whether anaesthetic and/or pain management strategies reduce risk of postoperative cognitive dysfunction in patients undergoing elective joint arthroplasty. Results indicated a greater incidence of early postoperative cognitive dysfunction for general anaesthesia. Postoperative pain management protocols that reduced narcotic use decreased incidence with morphine being associated with increases in incidences. Evidence on techniques for optimizing depth of general anesthesia, multimodal pain protocols and different regional anaesthesia techniques were inconclusive. The heterogeneity in results emphasize a need for standardized reporting methodologies.