Venous thromboembolic events remain a concern in total hip and knee arthroplasty. Consequently, several guidelines on thromboprophylaxis have been established. However, despite similarities in methodology for evaluation of evidence, discrepancies in guideline recommendations continue to exist. Furthermore, the results of older randomized clinical trials still have significant influence despite major improvements in perioperative care. In contrast, the results of recent large cohort studies with fewer thromboembolic events are mostly used only for background data. Here we outline some of the differences between the guidelines on thromboprophylaxis from the American College of Chest Physicians, the National Institute for Health and Care Excellence and the American Academy of Orthopedic Surgeons. We discuss differences in the methodology and focus of the guidelines potentially influencing the final recommendations. Future analyses are required, including data from modern care with early mobilization and short length of stay.