Background: Venous thromboembolic prophylaxis after major orthopaedic surgeries is an essential topic to review and has a lot of controversies and differences regarding which method to emphasize and the duration of each method of prophylaxis to be used in daily practice in orthopaedic surgery.Here we mentioned the review of literature with respect to thromboembolic prophylaxis in orthopaedic surgery including the latest guidelines and we made a meta-analysis of data from many studies regarding the use of different pharmacological agents after major orthopaedic surgeries like total hip replacement (THR), total knee replacement (TKR), hip fracture and knee arthroscopic surgery. Method: we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from 2010 till November 2019. The search retrieved 2089 unique records. We then retained 57 potentially eligible records for full-texts screening. Finally, 29 studies were included. Results: the rate of DVT was higher with DTI than with LMWH and lowest with FXaI, while the rate of PE was higher with DTI than FXaI and lowest with LMWH. The rate of major bleeding was higher with LMWH than with FXaI and lowest with DTI, indicating that FXaI has the lead in thromboembolic prophylaxis after THR or TKR with lower risk of bleeding compared to LMWH. Conclusion: FXaI was the most effective agent after THR and TKR. In hip fracture surgery and Knee arthroscopy, thromboprophylaxis is needed, but variable results regarding the drug choice warrant more research.