Abstract: Objective: To explore the incidence and risk factors of symptomatic Venous Thromboembolism (VTE) after total knee and hip arthroplasty. Methods: We prospectively observed 982 patients who underwent total knee and hip arthroplasty in the department of orthopaedics in our hospital from January 2015 to June 2016. Symptomatic VTE was diagnosed by doppler ultrasonography. We investigated the incidence and risk factors of symptomatic VTE, the diagnostic time of VTE, the variation of D-Dimer, and the vital signs and the chief complaint of the patients. Results: Totally 18 symptomatic VTE patients was diagnosed during hospitalization and the incidence was 1.8% (18/982) with 15 patients of symptomatic Deep Vein Thrombosis (1.5%) and 3 patients of symptomatic Pulmonary Embolism (0.3%). Logistic regression analysis indicated that the risk factors were age over than 72 (OR=2.768), the long hospitalized stay (OR=4.540) and medical history of cerebral infarction (OR=4.012), (P<0.05). Most patients diagnosed DVT and PE within the 7 days after surgery. D-Dimer of symptomatic VTE patients had a large variation and was apparently higher than normal range within the 7 days after surgery. VTE patients complained of pain or swelling in lower limb, and had the vital sign changes of SpO2 decreasing and transient loss of consciousness. Conclusion: The patients who are older than 72, long hospitalized stay and medical history of cerebral infarction are the high risk population of symptomatic VTE. Nurses should observe the clinical manifestation, the changes of vital sign and D-Dimer within 7 days after surgery, which is helpful to indentify VTE in early stage.