One hundred patients with osteoarthritis or femoral head necrosis were randomized to receive either a combination of tranexamic acid (TXA) and carbazochrome sodium sulfonate (CSS) (TXA + CSS; n=50) or TXA alone (n=50). The primary outcome of interest was total perioperative blood loss. Secondary outcomes of interest included hidden blood loss, intraoperative blood loss, postoperative blood transfusion rate, inflammatory reactant levels, range of motion, pain on a Numerical Rating Scale (NRS), length of stay, and the incidence of adverse events. Outcomes were assessed up to three days post-operation. Overall, the results of the study revealed that TXA + CSS experienced significantly lower total and hidden blood loss, as well as lower levels of inflammatory markers compared to TXA alone. There were no significant differences in pain, range of motion, length of stay, and the incidence of adverse events between the two groups. Therefore, the findings suggest that the combination of CSS and TXA is more effective in reducing blood loss and inflammatory response without increasing adverse events.