46 patients undergoing total knee arthroplasty to treat osteoarthritis were randomized to one of two postoperative leg positions: 60 degree hip elevation with 60 degree knee flexion, or with the leg in full extension. The purpose of the study was to determine if the flexion leg position reduced postoperative blood loss and affected functional recovery compared to a standard (extension) leg position. The flexion group displayed significantly lower total calculated blood loss and hidden blood loss compared to the extension group. Additionally, the flexion group had a significantly shorter duration of hospital stay, greater postoperative hemoglobin levels, lower postoperative knee circumference, and significantly better range of motion at 6 weeks postoperatively. No difference in blood transfusion requirement, intra-operative blood loss or postoperative complications were observed between groups.