119 patients scheduled for primary unilateral total knee arthroplasty were randomized to undergo the procedure either with combined intravenous and topical administration of tranexamic acid, or intravenous TXA administration alone. The purpose of this study was to compare total blood loss, allogeneic transfusion rate, hemoglobin drop, and the incidence of thromboembolic complications between groups. Results demonstrated significantly reduced total blood loss and hemoglobin drop with combined TXA administration versus IV TXA administration alone, though there was no significant difference between groups in transfusion rate. The rate of thromboembolic complications was low a did not differ between groups.