One hundred consecutive patients with osteoarthritis of the knee joint and scheduled for primary total knee arthroplasty performed in a bloodless field were prospectively randomized to have the tourniquet inflated on either straight leg or maximally flexed knee. There was no difference in the number of lateral releases between the groups, and position of the knee in maximal flexion during inflation of the tourniquet did not decrease the number of lateral releases. There was no difference in clinical or radiological patella tracking between groups. If the patella was maltracking, tourniquet deflation led to better patella tracking and saved 5 (31%) of 16 releases with no difference between groups. We recommend tourniquet deflation and reevaluation of patella tracking before performing lateral release in patellar maltracking.