Despite suggestions that tourniquet inflation during total knee replacement reduces bleeding and hence improves cement penetration, no studies exist supporting this widely held belief. In this single-blinded, single-surgeon, randomized controlled trial, the tourniquet inflation during cementation group (n = 20) did not have greater tibial cement penetration compared to a no tourniquet group (n = 20). No statistically significant differences in semiautomatic digitally measured average and central radiographic tibial plateau penetration values were observed between the two groups (p = 0.93; p = 0.84). Tourniquet inflation during cementation does not appear to improve tibial cementation penetration.