Thirteen studies including 946 elderly patients undergoing hip replacement surgery were analyzed in this systematic review and meta-analysis comparing TEAS to control or sham stimulation. Pooled outcomes of interest included pain levels assessed by 1-day and 2-day visual analogue scale (VAS) scores, cognitive function measured by 1-day and 3-day mini-mental state examination (MMSE) scores, postoperative cognitive dysfunction (POCD) rate, and adverse events such as nausea, vomiting, dizziness, and pruritus. The results demonstrated significantly lower VAS scores on both postoperative days and improved MMSE scores in the TEAS group. The incidence of POCD and adverse events were also significantly reduced in the TEAS group. These findings suggest that TEAS is a promising non-pharmacological intervention for improving perioperative pain and cognitive outcomes in elderly hip replacement patients.