100 patients scheduled for total knee arthroplasty and had the knee placed in 60 degrees flexion for the first 24 hours after surgery were randomized to surgery with or without intraoperative use of a tourniquet. Patients were assessed for outcomes related to blood loss, pain scores on a visual analog scale, knee range of motion, knee circumference, and incidence of complications. For blood loss outcomes, intraoperative blood loss was significantly lower in the tourniquet group, while postoperative blood loss to drainage and hidden blood loss were significantly lower in the non-tourniquet group. Total blood loss and transfusion rate did not significantly differ between groups. Pain scores and knee circumference were significantly higher in the tourniquet group for the first 5 days after surgery, and knee range of motion was significantly lower in the tourniquet group over the first month after surgery.