Objective: To investigate the occurrence and risk factors of symptomatic venous thromboembolism (VTE) after hip arthroplasty. Methods: A total of 300 patients undergoing hip arthroplasty admitted to Drum Tower Hospital, Nanjing University School of Medicine from October 2018 to October 2020 were selected. Patients with symptomatic VTE after surgery were included in the VTE group, and patients without symptomatic VTE after surgery were included in the non-VTE group. The clinical data and D-dimer levels of the two groups were compared, and the risk factors of symptomatic VTE after hip arthroplasty were analyzed by univariate analysis and logistic regression analysis. Results: Among the 300 patients, 15 cases of symptomatic deep vein thrombosis and 4 cases of symptomatic pulmonary embolism occurred. The incidence of symptomatic VTE was 6.33% (19/300); the age, type of surgery, length of stay, history of cerebral infarction, diabetes mellitus were compared between the two groups, and the difference was statistically significant (P<0.05). According to multivariate logistic regression analysis, age ≥72 years old, hospital stay >14 days, diabetes mellitus and history of cerebral infarction caused symptoms after hip arthroplasty were the risk factors for the occurrence of symptomatic VTE (P<0.05). The levels of D-dimer in the non-VTE group were higher on the 1st, 3rd, and 7th days after operation than the that in the VTE group, and the difference was statistically significant (P<0.05). Conclusion: The main risk factors for symptomatic VTE in patients undergoing hip arthroplasty surgery are high age, long hospital stay, diabetes mellitus and history of cerebral infarction. High-risk populations should be closely observed clinically, and the changes of D-dimer levels within 7 days after surgery should be closely monitored in order to take effective measures in time to reduce the occurrence of symptomatic VTE.