120 patients scheduled for total knee arthroplasty were randomized to one of four groups for wound closure: knee in flexion with the tourniquet deflated; knee in flexion with the tourniquet inflated; knee in extension with the tourniquet deflated, or knee in extension with the tourniquet inflated. The purpose of this study was to compare knee range of motion, pain, function, and wound complication rate at 1 week, 4 weeks, and 3 months follow-up. The knee flexion plus tourniquet deflated group demonstrated significantly greater knee ROM at 4 weeks postoperatively compared to the other three groups, and significantly lower pain scores at 1 week compared to all three groups. Results at 3 months demonstrated no significant between-group differences for either outcome measure. There were no significant differences in the incidence of wound complications or knee society scores between the 4 groups.