130 patients with knee osteoarthritis undergoing a total knee arthroplasty procedure were randomized to receive optimized tourniquet use (n=65) or no tourniquet (n=65) during the procedure. For the tourniquet group, inflation pressure was set at 100mmHg above systolic blood pressure, applied after exsanguination of the limb with a crepe bandage and prior to skin incision, and removed immediately after fixation of the prosthesis to the bone with cement. Outcomes of interest included blood loss, hemoglobin levels, pain in the knee and thigh, lower limb circumference as a measure of swelling, range of motion, Knee Society Score (KSS), the straight leg test, and complications. Follow-up was up to 6 months post-operation. The optimized tourniquet use and the no tourniquet group had similar blood loss, operative time, pain or swelling, functional scores, and complication rate, with the exception of range of motion which was significantly better in the tourniquet group at 3 weeks. Given the benefits of tourniquet use with respect to providing a clear surgical field, this optimized tourniquet protocol is a promising solution to minimize the tourniquet-related adverse events often reported. However, future studies with longer follow-ups and a wider range of patients are necessary to confirm the results.