BACKGROUND: A comparison of the postoperative effects of the use of tourniquet has been reported, but few literatures have clearly indicated differences in the effects of restrictive use of tourniquets and no use of tourniquets. OBJECTIVE: To investigate the effects of restrictive use and non-use of tourniquet in patients undergoing preliminary total knee arthroplasty within enhanced recovery after surgery mode. METHODS: Totally 90 patients who underwent total knee arthroplasty in Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from July 2017 to December 2018 were enrolled. The patients were randomly divided into three groups (n=30 per group) according to the method of the tourniquet during the operation. In the restrictive use group, after the osteotomy was completed, only the tourniquet treatment was applied when the prosthesis was installed, and the knee joint prosthesis was successfully placed and the cement was hardened. In the second half use group, after the osteotomy was completed, the tourniquet was used when the prosthesis was installed until the incision was sutured and pressure-wrapped. In the non-use group, no inflated tourniquet was used during operation. The same perioperative management and rehabilitation training were used in all patients of each group. Hemoglobin, C-reactive protein, visual analogue scale scores and HSS score were observed and compared between groups. RESULTS AND CONCLUSION: (1) Compared with the restrictive use group and the non-use group, the knee visual analogue scale scores and C-reactive protein level at 1 and 3 days after operation and the hemoglobin level at 1 day after operation both increased in the second half use group (P<0.05); however, the knee HSS scores at 3 and 7 days decreased (P<0.05). (2) There were no significant differences in visual analogue scale score, HSS score, C-reactive protein, and hemoglobin levels between the restrictive use group and the non-use group after surgery. (3) There was no significant difference in the early postoperative rehabilitation between the restrictive use and non-use tourniquet, but the use of tourniquets in the second half would aggravate early postoperative pain. [ABSTRACT FROM AUTHOR]