Background <p>To investigate the association between inflammatory indices-systemic immune-inflammation index (SII), monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and preoperative deep vein thrombosis (DVT) in patients undergoing total joint arthroplasty (TJA).</p> Methods <p>We created the receiver operator characteristic (ROC) curve using the ratios of SII, MLR, NLR, PLR to DVT before TJA, divided the enrolled patients into groups based on the cut-off value, and then analyzed risk factors for DVT before TJA in the multivariate binary logistic regression analysis.</p> Results <p>A total of 2125 patients were enrolled and preoperative DVT occurred in 110 cases (5.18%). Based on the ROC curve, we determined that the cut-off values for SII, MLR, NLR, and PLR were 470*10⁹ /L, 0.306, 2.08, and 127; and the areas under the curve (AUC) were 0.623, 0.601, 0.611, and 0.62. Multivariate binary regression analysis revealed that the risk of preoperative DVT in TJA patients with SII ≥ 470*10⁹/L, MLR ≥ 0.306, PLR ≥ 127, and NLR ≥ 2.08 increased by 2.26 (<i>P</i> &lt; 0.001, 95% confidence interval (CI) [1.52–3.37]), 1.92 (<i>P</i> = 0.002, 95% CI [1.28–2.9]), 2.1 (<i>P</i> &lt; 0.001, 95% CI [1.4–3.16]), and 1.94 (<i>P</i> = 0.002, 95% CI [1.29–2.92]) times, respectively. Age, <i>P</i> &lt; 0.001, odds ratio (OR) = 1.08, 95%CI [1.05–1.10]; corticosteroid use, <i>P</i> = 0.002, OR 3.8, 95% CI [1.94–9.22]).</p> Conclusion <p>We found that higher SII, MLR, NLR, and PLR levels, age, and corticosteroid use were independent risk factors for preoperative DVT in patients undergoing TJA.</p> Clinical trial registration <p>ChiCTR2100054844; Registration Date: 2021.12.28.</p>