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Introduction: There is no established evidence to support the use of drains after total knee arthroplasty (TKA). The aim of our study was to compare the requirement for blood transfusion after primary total knee arthroplasty with and without the use of closed suction drains and cost analysis of performing routine blood group and save. Material and methods: In this retrospective study, we reviewed the data over 3 and a half years duration including consecutive primary total knee arthroplasties. Patients were divided into drainage and non-drainage groups. Eleven surgeons used drains and two did not use drains. Results: 2497 primary total knee arthroplasties were performed during our study period by 13 surgeons. Postoperatively 7.5% patients (n=189) received blood transfusion. In the drainage group (n=2271), 7.3% patients (n=167) received transfusion with mean preoperative Hb of 12.1 g/dl (9.1 to 15.8 g/dl) and mean postoperative Hb of 7.9 g/dl (5.1 to 8.8 g/dl). In the non-drainage group (n=226), 9.7% patients (n=22) received transfusion with mean preoperative Hb of 12.1 g/dl (8.9 to 14.4 g/dl) and mean postoperative Hb of 7.7 g/dl (6.0 to 8.5 g/dl). Blood samples for 92.5% patients remained unused and eventually wasted. Annual cost of performing routine group and save for TKA patients at the time of our study in our department was nearly £20,000 and the annual cost of using drains for these patients was £51,000. Conclusion: We did not find any significant difference in blood transfusion requirement in the two groups. Selective group and save in these patients may prove to be cost-effective.