150 patients scheduled for primary unilateral total hip arthroplasty were randomized to one of three groups: a combined intravenous (IV) and topical tranexamic acid (TXA) protocol, IV TXA alone with topical placebo administration, or intravenous and topical placebo administration. The purpose of this study was to determine if the combined administration protocol demonstrated significantly greater efficacy in reducing blood loss and transfusion compared to IV TXA alone and placebo. The results of this study demonstrated that intraoperative blood loss, total blood loss, and transfusion rate were significantly lower with the combined IV and topical TXA protocol compared to both the IV TXA alone protocol and placebo group. There were no significant differences between the three groups in the incidence of deep vien thrombosis.