Total joint arthroplasty (TJA) is commonly performed on older adults. Prosthetic joint infection (PJI) is a serious complication of TJA that can significantly impact quality of life and physical function. In this review, we discuss the epidemiology and risk factors for PJIs among older adults. We also offer an overview of current diagnostic, treatment and management strategies for PJI. Given the serious nature of PJI, prevention efforts remain essential. Several approaches to infection prevention exist, including antimicrobial prophylaxis and decolonization. Although there are standardized recommendations for antimicrobial prophylaxis, the specific regimens must be individualized based on the patient's drug allergies, potential for drug interactions, renal function and bodyweight. The best approach to pre-operative screening and decolonization programmes remains unclear. Each of these issues is reviewed in detail with a focus on adverse effects and current debates regarding best practice. Given the increased numbers of TJAs performed, additional research on prevention and management is critical.