Ninety-four patients with primary knee osteoarthritis scheduled for unilateral total knee arthroplasty were randomized to receive exsanguination via Esmarch bandages (n=49) or simple leg elevation (n=45). The primary outcome of interest was surgical field visualization, assessed at four intraoperative stages. Secondary outcomes included operative time, intraoperative and total blood loss, postoperative pain, leg swelling, and complications. Outcomes were assessed intraoperatively and up to three days postoperatively, with complications monitored for one month. Overall, the results of the study revealed that the Esmarch group had superior surgical field visualization (p<0.001), but no significant differences in operative time, blood loss, or pain. However, knee swelling was greater in the Esmarch group. These findings suggest that while Esmarch bandages enhance visualization, they may increase postoperative swelling without improving other clinical outcomes.