One hundred and one patients undergoing primary total knee arthroplasty were randomized to receive an intraoperative thigh tourniquet or no tourniquet. The primary outcomes of interest were functional outcomes measured by the Knee Society Score (KSS) and Knee injury and osteoarthritis outcome score (KOOS) and postoperative thigh pain measured using the Visual Analogue Scale (VAS). Other outcomes of interest were operative time, blood loss, intraoperative visualization and complications. The no tourniquet group had significantly improved KSS and KOOS scores up to 2, 6 and 12 weeks postoperatively. Similarly, pain scores were lower in the tourniquet group up to 6 weeks postoperatively. No differences in functional outcomes or pain scores persisted at final follow-up. Operative time and visualization was improved in the tourniquet group. Intraoperative and total blood loss was lower in the tourniquet group. No differences in complications were noted.