Two hundred twenty-seven patients undergoing primary elective TKA were randomized to tourniquet (n=112) or no tourniquet (n=115). The primary outcome of interest for this post hoc 5-year analysis was implant survivorship (Kaplan–Meier aseptic survival) and all-cause revision; secondary outcomes included blood loss, operative time, length of stay, 90-day ED visits/readmissions, range of motion, and PROMs (KOOS JR; PROMIS domains). Outcomes were assessed preoperatively and at 3 months, 1 year, and 5 years. Overall, the results of the study revealed no significant differences between groups in aseptic survivorship at 5 years (log-rank P=0.769), all-cause revisions, ROM, or any PROMs at any time point. In short, tourniquet use during primary TKA did not alter mid-term clinical or patient-reported outcomes, suggesting the choice can be left to surgeon discretion.