Venous thromboembolism (VTE) is one of the most important complications in orthopedic surgery. Deep-vein thrombosis occurs frequently after surgery but has few clinical symptoms. The emboli formed may cause pulmonary thromboembolism, which is associated with a high mortality rate. The cost of medical care is doubled when VTE develops after surgery. Thus, it is imperative to focus on preventing VTE after major orthopedic surgery. The prevention method should be selected after considering the balance between VTE risk and bleeding risk attributable to drug prophylaxis. Physical prophylaxis, drug prophylaxis, or both should be selected. When performing VTE prophylaxis, the risks and merits of prophylaxis must be made clear to patients.