Background Elderly patients undergoing hip fracture surgery (HFS) are at increased risk of postoperative venous thromboembolism (VTE). Therefore, combined postoperative mechanical and chemical thromboprophylaxis has been routinely performed after HFS in these patients. This retrospective case-control study was conducted to evaluate the additional effectiveness of preoperative mechanical thromboprophylaxis on the prevention of VTE following HFS in elderly patients.Methods Of 539 consecutive patients aged 70 years or older undergoing HFS, 404 (control group) did not receive preoperative mechanical thromboprophylaxis while 135 (study group) received mechanical thromboprophylaxis using an intermittent pneumatic compression device and graduated compression stockings from the time of admission until surgery. All patients received combined postoperative mechanical and chemical thromboprophylaxis following HFS in accordance with the same protocol. The incidence of symptomatic VTE confirmed by clinical symptoms and 3-dimensional CT angiography within one month of surgery was investigated in both groups.Results American Society of Anesthesiologists grade was higher (p=0.016) in the study group and more patients in this group had concomitant cardiovascular and neurologic diseases (p=0.005 and p=0.009, respectively). Meanwhile, more patients in the study group had received anticoagulant medication preinjury owing to comorbidities (39% vs 28%, p=0.025). The overall incidences of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) were 7.4% and 3.7% in the control group and 2.2% and 1.5% in the study group, respectively. On multiple logistic regression, symptomatic DVT significantly reduced in the study group (OR 0.28, p=0.042), meanwhile there was no significant difference in the incidence of symptomatic PE between the two groups (p=0.223).Conclusions Preoperative mechanical thromboprophylaxis may confer an additional benefit by preventing postoperative VTE without adding more risk of perioperative bleeding in elderly patients with hip fracture.