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Introduction: Total knee arthroplasty (TKA) is commonly performed using tourniquet despite being associated with several recognised complications that may affect patient's post-operative recovery and early rehabilitation. In this study we investigate whether or not use of a tourniquet during TKA was associated with shorter length of stay, faster recovery and lesser complications. Methods: 29 patients, who underwent bilateral sequential TKA, had their first TKA under tourniquet and the second TKA 15 (11e32) months later without tourniquet. All operations were performed by the first author using the same technique and instrumentation with the same early rehabilitation protocol. All patients were followed prospectively for a minimum of 8 months. All patients had the following parameters measured which included surgical time, length of stay, postoperative pain using Visual analogue score (VAS), calf circumference, drop in haemoglobin, haematocrit level, oxford knee score (OKS), and range of motion (ROM). Results: TKA performed without the use of tourniquet had significantly shorter Length of hospital stay (3.6 vs 4.4, P < 0.05), significantly less pain on day 2 (1 vs 2; P < 0.05) and significantly smaller increase in calf circumference on day 2 (1.2 cm vs 2.3 cm; P < 0.05). Postoperative calf circumference increase of less than 2 cm in TKA without tourniquet was associated with shorter length of stay when compared with increase of more than 2 cm in TKA with tourniquet 2.9 days (SD 0.6) versus 3.9 days (SD 0.8) P < 0.05. ROM and OKS were significantly better in TKA without tourniquet at 6 weeks but no difference at 8 months. Conclusions: TKA done without tourniquet was associated with shorter length of stay, lesser pain and swelling, in addition to improved range of motion in the early post-operative period

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