Abstract: Objective To investigate the effect of local application of tranexamic acid on blood loss and transfusion rate of patients with femoral neck fractures after undergoing total hip arthroplasty(THA). Methods The data of 60 femoral neck fracture cases underwent unilateral THA in our hospital was retrospectively studied, and these patients were divided into two groups according to whether tranexamic acid was locally applied or not. The tranexamic acid group(n=30)was locally bathed with 170 mL tranexamic acid during the operation, while the control group(n=30)used no tranexamic acid during operation. The drainage packs were not allowed to connect with the drainage tubes until the tubes were clamped for 6 hours, and the drainage tubes were removed at 24 h after the operation. Blood transfusion rates were compared between the two groups. Intraoperative blood loss, postoperative drainage volume, occurrence of complications, hemoglobin(Hb)level and mean corpuscular volume(MCV)on the first day and third day after operation were recorded. Results The transfusion rate was 3.33% in the tranexamic acid group, which was significantly lower than 36.67% in the control group(P<0.05), the blood drainage volume at 24 hours postoperation was(130.00±63.03)mL in the tranexamic acid group, which was significantly less than(264.33±141.23)in the control group(P<0.05). The levels of Hb and MCV in the tranexamic acid group were significantly higher than those of the control group on the 1st and 3rd day after surgery(P<0.05). There was a statistically significant difference in the amount of Hb loss on the first day after surgery between the two groups(P<0.05), while no significant difference was found in two groups in the amount of Hb loss on the third day after surgery(P>0.05). No postoperative complications such as deep vein - thrombosis, pulmonary infection and incision infection occurred in the two groups. Conclusion Local application of tranexamic acid alone during THA in elderly patients with femoral neck fracture can significantly decrease the blood transfusion rate, reduce postoperative drainage volume and occult blood loss, and at the same time will not increase the risk of complications.