90 patients with osteoarthritis undergoing primary total knee arthroplasty were randomized to undergo the procedure either with or without the use of a tourniquet. The study was conducted in order to determine the effect of tourniquet use on cement mantle thickness, which is thought to play a role in implant stability and survivorship. The results of this study indicated that the tourniquet group had a significantly greater cement mantle thickness. However, the use of a tourniquet resulted in significantly increased postoperative pain and total blood loss.