BACKGROUND Total knee arthroplasty alleviates pain and restores function in patients with osteoarthritis of the knee, but it is associated with postoperative blood loss resulting in anemia and allogeneic blood transfusion in 10% to 38% of patients. Prepare tranexamic acid solution using aseptic technique. Apply tranexamic acid solution to the open joint and soft-tissue surfaces. Remove tranexamic acid, keeping the tourniquet inflated until the wound is closed and the dressing is applied. We showed, in a prospective, double-blinded, placebo-controlled randomized trial, that topical application of tranexamic acid directly into the surgical wound prior to closure at the end of a total knee arthroplasty reduces postoperative bleeding by 20% to 25%, or 300 to 400 mL. IndicationsContraindicationsPitfalls & Challenges.