120 patients scheduled for primary unilateral total knee arthroplasty without a tourniquet were randomized to one of three groups: one group was administered topical tranexamic acid via an intra-articular injection at the end of the procedure; one group was administered intravenous tranexamic acid at the beginning of the procedure; and one group did not receive tranexamic acid administration. Patients were assessed for total blood loss, transfusion rate, hemoglobin drop, and venous thromboembolic complications during the perioperative period. Results demonstrated significantly lower total blood loss, lower transfusion rate, and smaller corrected drop in hemoglobin level in each of the topical TXA group and the IV TXA group compared to the control group. No cases of venous thromboembolic complications were observed in any group.