Objective To investigate the preventive value of elastic stocking-lined padded pneumatic tourniquets for pressure injuries in patients undergoing total knee arthroplasty (TKA). Methods A total of 102 patients with primary knee osteoarthritis (KOA) who were admitted to Zhengzhou Central Hospital from August 2022 to August 2025 and were scheduled to undergo TKA. The patients were randomly divided into the elastic sock group (treated with pneumatic tourniquet with elastic sock liner) and the cotton paper group (treated with conventional pneumatic tourniquet with cotton paper liner) based on the random number table method, 51 cases in each group. The surgical-related indicators, pressure injury status, risk of pressure injury, incidence of skin damage complications, comfort level, and knee joint function were compared between the two groups. Results There were no statistically significant differences in the amount of blood loss and the total use time of tourniquet between the two groups (all P＞0.05). The visual field clarity of elastic socks group was higher than that of cotton paper group (P＜0.05). Within 7 days after operation, the total incidence of pressure injury in elastic sock group was significantly lower than that in cotton paper group (P＜0.01). Among the pressure injuries, all the elastic sock group suffered from stage Ⅰ injuries (100%), while 8 cases (88.89%) suffered from stage Ⅰ injuries and 1 case (11.11%) suffered from stage Ⅱ injuries in the cotton paper group. Before operation, there was no statistically difference in the scores of Braden between the two groups (P＞0.05). At 24 h and 3 days after operation, the Braden scores of the two groups were lower than those before operation, but the scores of the elastic sock group were higher than those of the cotton paper group at the same time (all P＜0.01). The total incidence of skin injury complications in elastic sock group was significantly lower than that in cotton paper group (P＜0.05). Comfort score and Hospital for Special Surgery (HSS) knee score of elastic sock group were significantly higher than those of cotton paper group (both P＜ 0.05). Conclusion The use of elastic stocking-lined padded pneumatic tourniquets in patients with TKA can not only improve the visibility, reduce the total incidence of pressure injury and skin injury complications, but also improve the comfort of patients and promote the early recovery of knee joint function without affecting the blood flow blocking effect of tourniquet.