Deep vein thrombosis and pulmonary embolism continue to be controversial areas for prophylaxis in orthopedic surgery. This patient population continues to have the highest incidence of deep vein thrombosis and pulmonary embolism when inappropriately or not prophylaxis for this complication. This article reviews the current modalities for prophylaxis with respect to their safety and efficacy. In addition, the new modalities of low molecular weight heparin and arteriovenous impulse system are presented.