Ten randomized controlled trials were included in this meta-analysis comparing blood loss and range of motion following total knee arthroplasty between knee positioning in flexion versus extension. Results demonstrated significantly lower calculated total blood loss and hidden blood loss with flexion protocols, but no significant difference in postoperative blood drainage volume. Transfusion rate was significantly lower with flexion versus extension procotols, and range of motion at 5-7 days postoperative was significantly higher with flexion versus extension protocols.