Introduction <p>The objective of the current study was to evaluate the reoperation rate among patients undergoing cemented total knee arthroplasty (TKA) with or without an intraoperative tourniquet.</p> Materials and methods <p>A retrospective cohort study of consecutive patients who received a primary, cemented TKA at a high volume academic orthopaedic center. Eligible patients underwent primary, cemented TKA either with or without the use of a tourniquet throughout the entirety of the care. The causes and timing of reoperations were recorded. Survivorship analysis was conducted using Kaplan-Meier curves. Cox proportional hazards models were utilized to evaluate independent predictors of reoperation.</p> Results <p>There were 2276 (58%) cases in which a tourniquet was used and 1663 (42%) cases with no tourniquet use. Mean time from the primary TKA was 14.7 years. The cumulative survival at final follow-up for the no tourniquet group and tourniquet group were 92.2% and 96.5%, respectively. Only younger age was an independent predictor of both all cause revision and aseptic loosening.</p> Conclusions <p>Adjusting for confounders, the presence of a tourniquet did not affect the rates of long-term all-cause revision rates or aseptic loosening. Younger patients have a higher risk of all-cause reoperation and reoperation due to aseptic loosening.</p> Level of evidence <p>Level III.</p>