Background: Total knee arthroplasty is associated with hematoma formation and extensive blood loss up to 1.5 liters. The placement of a closed suction drain to control this complication is controversial. The purpose of this study is to determine the efficacy between total knee arthroplasty without a drain and with a closed suction drain. Methods: A retrospective cohort study was conducted between January 2014 and December 2015 on 100 patients to assess the hemoglobin and hematocrit levels, the rate of allogeneic blood transfusion, and the length of hospital stay in patients with a closed suction drain versus no suction post-total knee arthroplasty.Results: Fifty-six units of packed red blood cells were transfused in 36 out of 50 patients (72%) in the closed suction group compared to 21 units of packed red blood cells in 18 out of 50 patients (36%) in the no suction group after 24 hours post-surgery. The hemoglobin levels at multiple intervals were lower in the closed suction group (p < 0.05). The closed suction group also had an extra one-day stay in the hospital (p = 0.0492, 95% CI = 0.70 - 0.94).Conclusion: Closed suction drain placement is associated with low hemoglobin levels, an increased rate of allogeneic blood transfusion, and a longer hospital stay.