Since arthritis of the knee is one of the most common pathologies in industrialized nations, there has been a growing interest in fast-track total knee arthroplasty (TKA). However, while one of the main concerns is the role of a tourniquet, the available data are inconclusive.This study sought to assess the link between postoperative outcomes and use of a tourniquet in TKA. Our goal was to determine whether it is justified to forego tourniquet use as indicated by the fast-track concept.The participants (n = 108) in this retrospective, non-randomized study were assigned into two groups after they satisfied the inclusion criteria: primary gonarthrosis or secondary gonarthrosis without previous arthrotomy. TKA was performed without (Group I, n = 55) or with (Group II, n = 53) a tourniquet. The postoperative outcome was evaluated in terms of postoperative pain, based on a numeric rating scale (NRS) and the need for pain medication, and postoperative function, based on range of motion (ROM) and walking tests.Overall, no significant correlations were observed between tourniquet use and postoperative pain according to the NRS. Group I required less oxycodone, but more non-opioids. There was no significant difference in the improvement in pre- to postoperative ROM with regard to tourniquet use. The final walking distance was significantly longer in Group I.These results suggest that there is no strongly significant link between the postoperative outcome and the use of a tourniquet. However, further studies will be needed to determine whether a tourniquet may have some other impact on TKA.