161 patients undergoing total hip arthroplasty for end-stage hip osteoarthritis were randomized to receive either topical tranexamic acid (TXA; n=82) or intravenous TXA (n=79). The primary outcomes of interest included postoperative pain on a Visual Analog Scale (VAS) and tramadol consumption for the first three postoperative days. Secondary outcomes included C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), total blood loss, and a decrease in hemoglobin. Pain scores were significantly better in the topical TXA group on postoperative day (POD) 1 with similar results on POD2 and 3 compared to intravenous TXA. Tramadol consumption was significantly lower in the topical group on POD 1 and 2. CRP, ESR, and IL-6 levels were significantly lower in the topical TXA group on POD1 but similar between the groups on POD2 and 3.