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BACKGROUND: Topical application of tranexamic acid can reduce the drainage after total hip arthroplasty for degenerative diseases. However, there are few reports on the application of tranexamic acid in primary total hip arthroplasty for simple elderly femoral neck fracture. OBJECTIVE: To analyze the safety and effectiveness of topical application of tranexamic acid to reduce drainage of elderly femoral neck fractures after total hip arthroplasty. METHODS: Forty-five elderly femoral neck fractures patients undergoing total hip arthroplasty in the Zhengzhou People’s Hospital from January to December 2019 were enrolled in this study, including 19 males and 26 females at the age of 59-82 years old. Twenty-one patients in the observation group were injected with tranexamic acid retrogradely through the drainage tube after total hip arthroplasty. Twenty-four patients in the control group were injected with normal saline retrogradely through the drainage tube after total hip arthroplasty. The postoperative drainage volume and adverse events were recorded; the wound healing was closely observed; and the coagulation function was checked. This study was approved by the Medical Ethics Committee of Zhengzhou People’s Hospital. RESULTS AND CONCLUSION: (1) All patients’ incisions healed grade A, and no myocardial infarction, cerebral infarction, pulmonary embolism, or deep vein thrombosis of the lower extremities occurred. (2) At postoperative 3 days, total drainage and hemoglobin loss were less in the observation group than those in the control group (P < 0.05). (3) Activated partial prothrombin time, prothrombin time, thrombin time, and fibrinogen were not significantly different between the two groups after surgery (P > 0.05). (4) Results suggested that topical application of tranexamic acid in total hip arthroplasty for elderly femoral neck fractures is safe and effective. It can significantly reduce postoperative drainage without affecting coagulation function. [ABSTRACT FROM AUTHOR]