**6. Authors' preference**

For the past decade, the authors focused on the effects of a tourniquet in TKA. In a meta-analysis [5], we found that using tourniquet in TKA may save time without evident hemostatic benefits. Then, a prospective, randomized, controlled trial was therefore conducted to clarify the effect of tourniquets in TKA. Reduced operative time, reduced intraoperative blood loss, and prevented excessive inflammation and muscle damage were obtained in the tourniquet-controlled TKAs [1]. Further, to save unnecessary ischemic duration, an effective hemostasis via a tamponade by the closed arthrotomy without drainage was used. Not only the shortened ischemic time but also better earlier functional recovery was obtained at early postoperative follow-ups [21]. Currently, although tourniquet is routinely used in our daily practice of TKAs, timely release as well as low cuff pressure is stressed based on the awareness of the risks of thromboembolism and other aforementioned complications.
