Abstract：[Purpose]To evaluate the value of controlled hypotension in total knee arthroplasty. [Methods]From September 2022 to January 2023, 125 patients with knee osteoarthritis underwent total knee arthroplasty. Among them, 60 patients were used tourniquet during operation (group TQ), while 65 patients were used controlled hypotension during operation (group CH). The early clinical outcomes were compared between the two groups. [Results]All patients in both groups were successfully operated on without obvious complications. The postoperative drainage volume, hidden blood loss, and total blood loss in the group TQ were significantly higher than those in the group CH (P<0.05). There was a significant increase in postoperative CRP and IL-6 levels in both groups of patients (P<0.05). For APTT and PT on the first postoperative day, and APTT on the third postoperative day, the group TQ was significantly lower than the group CH (P<0.05). For D-D, CRP, IL-6 on the first postoperative day and Fib, D-D, CRP, IL-6 on the third postoperative day, the group TQ was significantly higher than the group CH (P<0.05). The postoperative knee ROM and HSS scores of the two groups of patients significantly increased (P<0.05), but the early postoperative knee ROM and HSS scores of patients in the group TQ were significantly lower than those in the group CH(P<0.05). [Conclusion]The use of controlled hypotension in total knee arthroplasty can reduce total blood loss, alleviate postoperative hypercoagulability, reduce inflammatory reactions, and promote early rehabilitation of knee joint function after surgery.