60 patients scheduled for unilateral total knee arthroplasty were randomized to either combined intravenous and intra-articular tranexamic acid administration, or intravenous TXA administration alone. The purpose of this study was to determine if combined IV-IA TXA administration offered lower 24-hour blood loss compared to IV administration alone. In addition to significantly lower 24-hr blood loss noted in the combined IV-IA TXA group compared to the IV TXA group, 2-day blood loss was also significantly lower. Only one patient overall required transfusion, and no patient developed venous thromboembolic complication.