Purpose of Review <p>This review summarizes current literature investigating the effect of neuraxial anesthesia versus general anesthesia on rates of postoperative acute kidney injury (AKI) in lower extremity joint arthroplasty.</p> Recent Findings <p>AKI can occur in 2–15% of patients following total hip arthroplasty (THA) and total knee arthroplasty (TKA), which can lead to significant morbidity, mortality, and increased readmissions and costs. Several large studies have consistently found a reduction in postoperative morbidity and healthcare costs when neuraxial anesthesia was used over general anesthesia in joint arthroplasty. Many of these studies also showed a lower odds ratio of AKI when neuraxial anesthesia was used. While the cause of acute kidney injury is often multifactorial, choice of anesthetic may influence odds of developing postoperative AKI.</p> Summary <p>Neuraxial anesthesia for lower extremity total joint arthroplasty may have lower rates of postoperative AKI compared to general anesthesia.</p>