Eighty-one patients scheduled to undergo elective periacetabular osteotomy (PAO) were randomized to receive IV tranexamic acid (TXA; n=40) or intravenous (IV) normal saline (n=41). The primary outcome of interest was total peri-operative calculated blood loss. The secondary outcomes of interest included the incidence of allogeneic transfusion, length of hospital stay, incidence of complications at 6-weeks follow-up, and peri-operative cell saver usage. The results of this randomized controlled trial demonstrated that the primary outcome was statistically significantly reduced in the TXA group vs saline group (1,264.6 mL [SD 321.4] vs 1,515.4 mL [SD 393.9]; p=0.002). Furthermore, the incidence of allogenic transfusions was statistically significantly lower in the TXA group compared to the saline group (4 vs 15; p=0.008). All other outcomes were not statistically significantly different between the 2 treatment groups (p>0.05). Regression analysis was also conducted adjusting for factors including age, sex, BMI, pre-operative hemoglobin, cell-saver volume, peri-operative mean arterial pressure, and surgical time -- regression results suggested that using IV TXA was a predictor of lower calculated blood loss (p<0.001) and a negative predictor of allogenic transfusion use (p=0.007).