Tourniquet use in total knee arthroplasty remains controversial. Purported benefits include improved hemostasis and lower rates of blood loss and transfusion. On the other hand, tourniquet use can lead to post-operative pain, cause damage to blood vessels, and increase fibrinolytic activity leading to thrombosis. This meta-analysis of 11 randomized controlled trials (RCTs) included a total of 541 patients. They found that tourniquet use significantly decreased intra-operative blood loss, calculated blood loss, and operative time, but did nit significantly affect post-operative blood loss, total blood loss, rate of transfusion, or rate of deep vein thrombosis. Overall, further research is needed, but it appears that tourniquet use may only affect surrogate outcomes and not patient-important endpoints.