Elderly patients often suffer from associated with fundamental diseases, with high risks of perioperative myocardial injury. Due to weakened compensatory capacity, severe myocardial injury once occurs, often cause irreversible poor prognosis. It is necessary to summarize the risk factors of perioperative myocardial injury, and take effective measures to reduce the incidence of adverse cardiovascular events as much as possible. The current review is to investigate the possible risk factors of perioperative myocardial injury during orthopedic surgery at different stages of perioperative surgery and the mechanism of different risk factors to impair myocardium. At present, the following measures can be adopted by patients suffering from fundamental diseases like diabetes and hypertension for myocardial protection: ischemic preconditioning, opioids, capsaicin and those related molecular mechanisms are hot topics. In the future, drugs may be adopted to block myocardial injury pathway for myocardial protection.