To eliminate the need for allogeneic blood transfusion in patients undergoing elective total knee arthroplasty, we established and tried a protocol of combined methods, which is characterized by effectiveness, ease in application, and safety. It is based on perioperative administration of human recombinant erythropoietin plus iron and folic acid, mild acute normovolemic hemodilution, meticulous surgical technique, postoperative blood salvage through a closed-wound drainage system, and lower transfusion triggers.