Abstract Objective To systematically evaluate the effectiveness and safety of topical administration of tranexamic acid for total knee arthroplasty. Methods Databases including PubMed, EMbase, CENTRAL (Issue 3, 2015), WanFang Data, CBM, CNKI were searched to collect the randomized controlled trails (RCTs) about tranexamic acid for total knee arthroplasty from inception to March 2015. the meta-analysis was conducted using RevMan 5.3 software. Results A total of 16 RCTs involving 1533 patients were included. 10 RCT compared with placebo and 6 RCT compared with intravenous usage. The results of meta-analysis showed that: Compared with placebo, the incidence of transfusion rate and Total blood loss had reduced (P＜0.00001); However, there was no significant difference in the incidence of deep venous thrombosis. Compared with intravenous TXA, There was no significant difference in the incidence of transfusion rate and deep venous thrombosis( P=0.55、0.58、0.52). Conclusion Topical TXA is an effective and safe method of reducing the need for blood transfusion after total knee arthroplasty. Compared with intravenous TXA, Topical TXA had no clear superiority. Due to the limited number of research, the above conclusion is still needed more research to be verified.