Two hundred and thirty patients undergoing a cemented total knee arthroplasty without tourniquet were randomized into receiving either topical tranexamic acid (TXA) or control. The primary outcome of interest was total amount of blood loss. Secondary outcomes of interest included hemoglobin and hematocrit levels, length of hospital stay, transfusion rates, and operation time. Furthermore, knee range of motion, Knee Society Scores (KSS), Western Ontario and McMaster Universities (WOMAC) pain and function scores, and Short-Form 12 (SF-12) quality of life scores were measured at 3 months follow-up. Results found that the primary outcome of total blood loss was significantly lower in the TXA group compared to the control. Furthermore, hemoglobin and hematocrit values were significantly higher in the TXA group. Length of hospital stay was significantly lower in the TXA group, and transfusion rates were significantly lower in the TXA group compared to control (0% vs 4.3%). No cases of deep vein thrombosis and pulmonary embolism were observed in any of the 2 treatment groups.