BACKGROUND: Patient optimization is receiving increasing attention as outcomes monitoring and bundled payments have been introduced in joint arthroplasty. Optimization of nutrition is an important aspect of perioperative management. METHODS: This manuscript is a review of previously published material related to nutrition and the impact of malnutrition on surgical outcomes, with guidance for surgeons preparing patients for elective joint arthroplasty. RESULTS: Patients with optimized nutritional parameters have fewer complications, especially related to wound healing and infection. CONCLUSION: Nutritional assessment and optimization should be a part of the perioperative management of patients undergoing lower extremity arthroplasty.