62 hips and 115 knees were included in this randomized controlled study comparing a standard drain, an autologous reinfusion drain, and tranexamic acid (TXA) for blood loss during total joint arthroplasty. The purpose of the study was to compare the safety, efficacy, and cost-effectiveness of the three options. Outcomes included change in hemoglobin (HG), incidence of allogenic blood transfusion, percent autologous blood reinfused, and hospital costs. Results indicated that tranexamic acid was able to mitigate hemoglobin drop more significantly than either reinfusion drains or standard drains. Autologous drains were the most expensive option, and patients who received autologous reinfusion drains demonstrated similar hemoglobin levels. Transfusion rate was not found to significantly differ between groups.