One hundred patients diagnosed with end stage osteoarthritis and undergoing total knee arthroplasty (TKA) were randomized to have their knee positioned either at a 45 degree flexed position, or a fully extended position after the procedure. The purpose of this study was to assess the effects of knee positioning on blood loss and range of motion (ROM) recovery. Results demonstrated significantly lower 48-hour calculated blood loss and hidden blood loss in the flexion group compared to the extension group, as well as significant higher hemoglobin levels at 48 hours postoperatively. Length of hospital stay was also significantly shorter in the flexion group. Knee range of motion was comparable between the flexion and extension groups at 6 weeks postoperatively.