Blood transfusion is often required during major orthopaedic surgery due to excessive blood loss, especially with joint arthroplasty, spinal fusion, and fracture repair. Despite the medical importance of transfusion in saving lives, new knowledge indicates that transfusion could have adverse effects on bone healing and bone regeneration. Physiological effects of blood transfusions on bone repair, particularly potential delays in inflammatory responses, impaired oxygen delivery, prolonged inflammation, and increased bone resorption, are the foci of this article. Understanding how transfusion-related immunomodulation and changed cytokine activity disrupt bone regeneration is essential for optimizing post-operative outcomes. Strategies to reduce the need for transfusion-inclusive blood-conserving techniques and pharmacological agents such as tranexamic acid and erythropoietin are presented. This article reviews the available literature to offer comprehensive understanding regarding how blood transfusions might influence bone healing in orthopaedic surgeries while simultaneously presenting potential alternative strategies to improve the outcomes for the patients.