The administration of tranexamic acid to decrease blood loss in primary total hip replacement is established. In this observational study three different regimes of tranexamic acid were used to investigate the effects of combined intravenous and topical administration of tranexamic acid to a single intravenous bolus given at induction or closure. Group 1 (n = 50) received 1 g tranexamic acid intravenously at induction and 500 mg tranexamic acid topically during closure. Group 2 (n = 50) received 1 g tranexamic acid intravenously at induction. Group 3 (n = 50) received 1 g tranexamic acid at closure. The mean haemoglobin loss was 2.83 g/dL (95% Confidence interval [CI] 2.51 to 3.15 g/dL) in Group 1, 2.92 g/dL (95% CI 2.65 to 3.19 g/dL) in Group 2 and 3.36 g/dL (95% CI 2.94 to 3.77 g/dL) in Group 3. No significant difference in mean haemoglobin loss was found (p = 0.123). In this observational, non-randomised study we found no additional advantage to giving topical tranexamic acid at closure in addition to intravenous tranexamic acid given at induction.