Background Although music interventions on postoperative pain (POP) have positive effects, limited research has focused on systematic reviews and meta‐analyses of its efficacy for orthopedic patients. This systematic review aimed to examine the effects of music therapy on pain after orthopedic surgery. Method The Cochrane Library, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Nursing Reference Center (NRC), Airiti Library, and National Digital Library of Theses and Dissertations in Taiwan were searched up to August 2019. The risk of bias from the Cochrane Handbook for Randomized Controlled Trials of Interventions was used. A standard mean difference (SMD) with 95% confidence intervals (CIs) was applied as a summary effect on postoperative pain and anxiety using RevMan version 5.3. A meta‐analysis was also carried out using subgroup analysis. Results Nine randomized controlled trials were selected. (1) Music can relieve pain significantly for both music medicine (MM; SMD = −0.41, 95% CI [−0.75, −0.07], P = 0.02) and music therapy (MT; SMD = −0.31, 95% CI [−0.57, 0.04], P = 0.02). (2) Music chosen by the subjects showed significant differences for both MM (P = 0.002) and MT (P = 0.02). (3) Anxiety improved significantly among patients using MT (SMD = 0.44, 95% CI [−0.75, −0.13], P = 0.005). However, the results for the physiologic parameters, opioid requirement, and length of stay showed subtle distinctions. Conclusion Music can significantly relieve POP, specifically music chosen by the participants.