Nine randomized controlled trials which compared rivaroxaban to enoxaparin for thromboprophylaxis in total knee and total hip arthroplasty were selected for inclusion. Meta-analysis was performed for incidences of symptomatic venous thromboembolism (VTE), major bleeding, clinically-relevant non-major bleeding, all-cause mortality, and postoperative wound infection. Trial sequential analysis was also performed to supplement results on incidence of symptomatic VTE and major bleeding events. Results demonstrated a significantly lower rate of symptomatic VTE, particularly symptomatic deep vein thrombosis, with rivaroxaban versus enoxaparin, but also a significantly higher incidence of major bleeding events. Trial sequential analysis demonstrated required information size for symptomatic VTE had been met and suggested that further data would unlikely change results, whereas required information size for data on major bleeding had not been met, and further data was needed regarding this outcome.