85 patients with end stage knee arthritis scheduled to undergo total knee arthroplasty (TKA) were randomized to receive tranexamic acid (TXA) administered either topically or intravenously. The purpose of this study was to compare the efficacy and safety of these two treatment approaches. Results indicated that TXA when topically-applied, resulted in similar haemoglobin values, postoperative drain output, and tourniquet time, as when TXA was administered intravenously. Postoperative blood transfusion was not required for any patient. Both treatment approaches were safe, with no incidences of deep vein thrombosis (DVT), pulmonary embolism (PE), or wound infection.