12 studies including 1179 knees, evaluated topical tranexamic acid (TXA) administration versus a control in total knee arthroplasty. The goal of this meta-analysis was to determine the safety and efficacy of topical administration of TXA in total knee arthroplasty. The results revealed that topical administration of TXA significantly decreased total blood loss, transfusion rate, postoperative drain output, and postoperative hemoglobin drop without increasing the risk of DVT and PE. Additionally, subgroup analysis found that higher concentrations of TXA had a greater effect on the reduction of blood loss and the rate of transfusion.