One hundred sixty-four patients undergoing primary unilateral total knee arthroplasty were randomized to receive either the unipolar electrocautery system (n=82) or the saline-coupled bipolar sealer system (n=82). The primary outcome of interest was estimated blood loss on postoperative day 1. Secondary outcomes included the difference in hemoglobin levels from preoperative to postoperative day 1, allogeneic blood transfusion rates, Knee Society Scores (KSS), and adverse events up to 90 days. Overall, the results revealed no clinically significant differences in blood loss or outcomes between the two groups, with the unipolar electrocautery system being noninferior. The study concluded that the use of the bipolar sealer adds cost without improved clinical benefit.