One hundred one patients with knee osteoarthritis undergoing primary unilateral total knee arthroplasty were randomized to receive oxidized regenerated cellulose (n=34), topical tranexamic acid (n=34), or no hemostatic treatment (control, n=33). The primary outcomes of interest were total blood loss, hemoglobin drop, transfusion rates, and incidence of thrombosis. Secondary outcomes included operation time, tourniquet duration, coagulation parameters, inflammation markers, and complication rates. Outcomes were assessed over a 6-week postoperative period. Overall, the results of the study revealed that both ORC and TXA significantly reduced total blood loss compared to the control group, with no statistical difference between ORC and TXA. No differences in complication rates were observed. These findings suggest that ORC is a viable and safe alternative to TXA for reducing blood loss in TKA, particularly in patients with TXA contraindications.