Background: Total hip arthroplasty could be associated with major intra-operative as well as post-operative blood loss. Post-operative anaemia is a recognized complication which can prolong hospital stay, delay rehabilitation and is poorly tolerated by elderly patients. Blood transfusion carries the risk of infections, anaphylaxis, etc. We examined whether tranexamic acid given before and after total hip arthroplasty reduces intra-operative, post-operative and total operative blood loss and whether the need for post-operative blood transfusion is reduced.