This meta-analysis was comprised of 15 randomized controlled trials (804 patients) comparing the efficacy and safety of tourniquet versus non-tourniquet application in total knee arthroplasty (TKA). Pooled results, revealed tourniquet application significantly reduced intraoperative blood loss but increased postoperative loss. There was no significant difference between tourniquet versus non-tourniquet TKA with respect to total blood loss, calculated blood loss, duration of surgery, incidence of deep vein thrombosis, or incidence of pulmonary thromboembolism. It should be noted that the GRADE system ranked evidence as lower strength.