OBJECTIVE: To explore the application of the technique of reducing bleeding and striving for no blood transfusion in total knee arthroplasty. METHODS: Through a retrospective study, 100 patients who underwent initial total knee replacement from August 2007 to May 2009 were selected and divided into a control group, a small-dose group, and a high-dose group based on whether or not microporous polysaccharide hemostatic bulbs were used intraoperatively and the dose. Surgical time, surgical blood loss, blood transfusion volume, blood transfusion rate and the number of postoperative embolic complications occurred were used as evaluation indexes for comparison. RESULTS: No blood transfusion was required in 98/100 patients in the high-dose group, and only 2 patients with bilateral replacement required blood transfusion, and the amount of blood transfusion was small. There was a significant difference with other groups. There was no statistically significant difference in the operation time of each group, no statistically significant difference in intraoperative bleeding, and the postoperative visible and total blood loss of the test group was smaller than that of the control group, and the blood transfusion rate was smaller than that of the control group. No embolic complications were found in any of them. CONCLUSIONS: The high-dose use of microporous polysaccharide hemostatic balloon, combined with the use of tourniquet, can effectively reduce the total blood loss in total knee arthroplasty, reduce the transfusion rate, and do not increase the occurrence of complications. The intraoperative use of controlled hypotension, patellar non-handling technique, and small stripping technique of the medial collateral ligament combined with medial femoral intramuscular approach technique, thus reducing soft tissue injury during surgery and shortening the operating time, all contribute to reducing surgical blood loss and achieving the goal of less or even no blood transfusion. This is of significant clinical significance for saving valuable blood resources and reducing complications, and is worthy of clinical promotion.