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Objective   To investigate the efficacy and safety of performing primary unilateral total knee arthroplasty (TKA) in the “Si hour-period” meaning 09:00 a.m. to 11:00 a.m. (one of the 12 two-hour periods into which the day was traditionally divided, each being given the name of one of the 12 earthly branches), compared with the “Wei hour-period” (13:00–15:00).Methods   Patient documentations were studied for those who underwent a primary unilateral TKA performed by the same surgical team with a tourniquet between January 2018 and January 2021 at our medical center. Eighty-four patients were enrolled and assigned into group A (in Si hour-period) and group B (in Wei hour-period). The main outcomes were total blood cell loss (TBL), hidden blood loss (HBL), visible blood loss (VBL), maximum hemoglobin (Hb) drop, and transfusion rate. Secondary outcomes were length of hospital stay (LOS), postoperative femorotibial mechanical axis (FTMA), FTMA correction, platelet count, plasma D-dimer (D-D), prothrombin time (PT), international normalized ratio (INR), and the incidence of postoperative complications.Results   Group A showed statistical significance lower at the mean TBL, the mean HBL, and the maximum Hb drop (95%  CI : −352.8 to −46.1, P =0.011, 95%  CI:  −348.0 to −40.1, P =0.014, and 95%  CI:  −9.5 to −0.7, P =0.023, respectively) after TKA than group B. The postoperative platelet count of group A was more significant than that of group B (95%  CI :3.1 to 52.9,  P =0.028). The VBL, transfusion rate, the LOS, postoperative FTMA, FTMA correction, plasma D-D, PT, INR, and the incidence of postoperative complications (wound complications, calf muscular vein thrombosis, infection, pulmonary embolism, and deep vein thrombosis) were similar between the two groups ( P  > 0.05, respectively).Conclusion   Our study shows that blood loss can be reduced when TKA is performed in the “Si hour-period,” which may be due to increasing platelet count, and postoperative complications did not increase, compared with the Wei hour-period. We recommend that the selective operation, such as TKA, should be performed in the “Si hour-period” in clinical practice between the two hour-period.

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Perioperative Blood Loss Can Be Reduced If Total Knee Arthroplasty Was Performed in the Si Hour-Period, Compared with the Wei Hour-Period: A Retrospective Cohort Study