[Objective] To compare the effects of three perioperative blood managements during total hip arthroplasty (THA) in the el- derly. [Methods] From August 2018 to October 2021, a total of 60 elderly patients who were undergoing unilateral total hip arthroplasty for corticosteroid-induced osteonecrosis of the femoral head were included in this study and were divided into three groups by random number table method. Of them, 20 patients in conventional group were treated with tranexamic acid, 20 patients in hydrogen-rich group were treated with tranexamic acid and hydrogen-rich water, while the renmaining 20 patients in the combined group had tranexamic, hydrogen-rich wa- ter and received additionally postoperative intravenous iron. The document regarding clinical presentations and laboratory test, as well as their correlation were analysized. [Results] All patients in the three groups had THA completed successfully. Although no significant differ- ences in the operation time and intraoperative blood loss were found among the 3 groups (P>0.05) , the combined group had significantly less postoperative drainage volume, total blood loss and invisible blood loss than the other two groups (P<0.05) . Some patients in the three groups had blood transfusion after operation, and the number of patients in the combined group was the least (P<0.05) . In addition, VAS score of the combined group was significantly lower than those of the other two groups (P<0.05) . The hip range of motion (ROM) and Harris score in- creased significantly over time in all the 3 groups (P<0.05) , which proved significantly better in the combined group than the other two groups at the corresponding time point (P<0.05) . Additionally, hemoglobin (Hb) and hematocrit (Hct) had the highest level in the combined group compared with the other two groups (P<0.05) , while IL-6 was the lowest in the combined group at corresponding time point (P<0.05) . In terms of CRP, the combined group was significantly lower than the other two groups from 3 to 7 days after operation (P<0.05) . What is more, it was found that there was a certain correlation between the clinical results and the laboratory indicators. [Conclusion] Tranexamic acid combined with hydrogen-rich water and iron does significantly alleviate the pain, promote the recovery of Hb and Hct, improve function- al recovery during perioperative period of THA for corticosteroid-induced femoral head necrosis in the elderly.