The Global Orthopaedic Registry (GLORY) offers insights into multinational practice patterns of venous thromboembolism (VTE) prophylaxis in orthopedic surgery, based on data from 15,020 patients undergoing primary total knee arthroplasty or primary total hip arthroplasty from 2001 to 2004. Registry data show that the first choice for in-hospital VTE prophylaxis was low-molecular-weight heparin. Multimodal prophylaxis was common. Warfarin was more widely used in the United States than elsewhere in the world. GLORY data suggest that real-world practice often fails to meet the standards for prophylaxis recommended in the American College of Chest Physicians evidence-based guidelines, particularly in the United States. However, many US orthopedic surgeons may follow other practice guidelines, causing an underestimation of prophylaxis use in this study. Warfarin use in the United States often failed to achieve recommended target international normalized ratio (INR) values. This paper reviews the GLORY practice findings in light of the contemporary literature on best practices for VTE prophylaxis in orthopedic patients.