7 studies were analyzed in this meta-analysis, (2 high quality randomized control trials (RCT), 3 lower quality RCTs (quasi-randomized/level of evidence 2), and one prospective case control), to determine the efficacy of topical tranexamic acid (TA) on blood loss following total knee arthroplasty. The pooled data of these trials revealed total drain output, total blood loss, and risk of transfusion were all reduced with topical tranexamic acid without increasing the risk of thromboembolic events. A subgroup analysis indicated that higher doses significantly reduced transfusion requirements.