Five randomized controlled trials and one prospective cohort study were analyzed with a total of 679 patients and 739 knees in this level II meta-analysis comparing topical and intravenous administration of tranexamic acid for patients undergoing total knee arthroplasty. The purpose of this analysis was to investigate whether there was a difference in efficacy between the two modes of administration. No significant differences were found between topical and intravenous administration regarding amount of blood lost postoperatively, number of transfusions required for each patient, and the rate of thromboembolic complications. The results indicated that topical tranexamic acid and intravenous tranexamic acid are equally effective.