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The discussion as to whether or not to use closed suction drainage (CSD) after total knee arthroplasty (TKA) is still ongoing. A multitude of surgical techniques makes comparison between studies difficult. The aim of the present study was to investigate the benefit of CSD versus nondrainage following primary TKA when operating after exsanguination (by means of a rubber Esmarch bandage) with a tourniquet and without any form of hemostasis. A prospective randomized trial was performed with a homogeneous sample of 36 patients with strict inclusion and exclusion criteria. Patients were evaluated preoperatively, on a daily basis during their hospital stay, and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The use of CSD led to a significantly stronger drop in hemoglobin levels by approximately 1 g/dL (p = 0.012). Knee circumference, wound secretion, wound healing, and postoperative range of motion did not show significant differences. All discharge criteria were met in both groups by day 9. Interestingly, patients without CSD reported higher pain levels during the entire postoperative inpatient stay and also at the 6-week follow-up (p = 0.012). These differences could not be observed in longer follow-up. The use of CSD after primary TKA in this study did not lead to indispensable advantages but did lead to increased postoperative blood loss. When evaluating the advantages and disadvantages of the use of CSD after TKA from the data in the literature, special attention must be paid to the operating technique, as it has a strong impact on the results obtained.