Surgical site infections after lower extremity total joint arthroplasty procedures remain a substantial economic burden to the patient, the treating institution, and the healthcare system. The complexity of these surgical procedures creates the potential for various patient-related or surgery-related risk factors for infection. Although there is much literature regarding the use of many preventative methods, a consensus regarding the true efficacy and application of such practices generally is not available. In this review, we evaluated selected preventative measures including: the Centers for Disease Control and Prevention recommendations, skin preparation techniques, surgical draping techniques, operative dress, operating room ventilation, hair removal techniques, as well as operating room traffic control. Our literature review consisted of searching PubMed, EMBASE, Ovid, and other relevant orthopaedic journal databases. Preference was given to randomized-controlled trials, data from national registries, and meta-analyses within the past 5 years written in the English language. After reviewing the available literature, we present the authors’ current preferred infection prevention methodology and protocol.