200 patients scheduled for total knee arthroplasty with tourniquet use (inflated prior to incision and deflated before wound closure) were randomized to surgery with or without the application of a fibrinogen topical spray following the cementing of components. Hemostatic parameters of hemoglobin and hematocrit levels, total blood loss, and transfusion requirements were monitored over the first 3 postoperative days. Clinical assessment was also conducted at 6 week follow-up. The results indicated that there were no significant differences in total blood loss and transfusion needs between the groups. Postoperative drain volume was significantly higher in the group treated with topical fibrinogen when drains were removed at 24 hours.