10 randomized controlled trials which compared postoperative leg position in knee flexion versus extension following total knee arthroplasty were included in this meta-analysis. The purpose of this meta-analysis was to compare data on blood loss, transfusion incidence, knee range of motion, and complications between groups. Pooled results demonstrated significant differences in favour of postoperative flexion compared to extension for total and hidden blood loss, postoperative day 1 hemoglobin level, transfusion rate, and postoperative knee range of motion. No significant differences were demonstrated between flexion and extension protocols in rates of deep vein thrombosis or wound infection.