16 randomized controlled trials were included in this meta-analysis examining the effect of tourniquet release prior to, or following, wound closure on operative blood loss and incidence of complications during total knee arthroplasty (TKA). Perioperative, postoperative and total blood loss, rate of major and minor complications, and operative time were assessed. The results of this analysis demonstrated that removal of the pneumatic tourniquet prior to wound closure significantly increased blood loss, although it lowered the risk of complications among patients when compared to tourniquet removal following wound closure.