Background: Venous thromboembolism (VTE) is the third leading cause of cardiovascular-associated death worldwide, and VTE prevention is one of the top patient safety strategies that hospitals can adopt. This study aimed to understand patients' perceptions of VTE prevention related to major orthopedic surgery in order to guide the clinical practice of medical staff and improve patient quality of life. Patients undergoing major orthopedic surgery should receive interventions to prevent VTE. To encourage patient participation, these interventions should be patient-centered. However, few studies have examined the perceptions of VTE prevention among patients undergoing major orthopedic surgery. Methods: Participants were purposively selected from among patients undergoing major orthopedic surgery in the orthopedic department of a level-three, class-A hospital in Beijing, China. Data were collected through in-depth semi-structured interviews, and findings were based on a thematic content analysis. All interviews were held during each patient's hospital stay. Results: From eight patients who participated, the following themes were identified: (1) unclear understanding of VTE, (2) poor understanding of the severity of postoperative VTE, and (3) poor understanding of VTE prevention. Conclusions: There are weak links in clinical care related to VTE prevention. We should aim to more completely understand patients' needs, strengthen the health education provided to patients, and improve patient adherence to preventative measures.