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Objective To evaluate whether closed suction drainage ( CSD) is associated with early recovery of knee function in patients undergoing total knee arthroplasty ( TKA). Methods Between January 2015 and September 2015, 80 consecutive patients were prospectively randomized into two groups: a CSD group (40 cases; average age, 66.9 ± 8.6 years; male, 8; female, 32) and a non- CSD group (40 cases; average age, 66.8 ± 10.1 years; male, 9; female, 31). Local inflammation outcomes (assessed by a visual analog scale [ VAS], swelling and skin temperature), calculated total blood loss ( CBL), hidden blood loss ( HBL), blood transfusion requirements and hemoglobin concentrations were recorded. Hospital for Special Surgery ( HSS) knee scores, range of motion ( ROM), limb swelling, tension vesicles, ecchymosis, time to regaining straight leg raising and duration of hospital stay were documented. All surgeries were performed by the same surgeon and followed up for 3 months. Results The peri-wound skin temperature and knee VAS pain scores were lower in the non- CSD group. Patients in the non- CSD group had significantly better knee ROM ( P = 0.028). The time to regaining active straight leg raising was significantly shorter in the non- CSD group N than in the CSD group ( P = 0.014). In addition, patients in the non- CSD group had a shorter length of hospital stay ( P = 0.004) than those in the CSD group, indicating earlier recovery of knee function. HBL was significantly less in the CSD group than the non- CSD group ( P = 0.006) on postoperative day ( POD) 5. However, CBL did not differ significantly between the two groups on POD5. There were no significant differences between two groups in all other assessed variables. Conclusion In this randomized study, primary TKA without CSD was associated with faster recovery related to less local inflammation and better early knee function. Furthermore, use of a drain had no significant advantage with respect to other outcome measures and may have increased costs. Based on these data, CSD after primary TKA is not routinely indicated. [ABSTRACT FROM AUTHOR]