Eight randomized controlled trials including 675 patients with hip osteoarthritis were included in this systematic review and meta-analysis comparing perioperative systemic steroid administration versus placebo in elective total hip arthroplasty. Pooled outcomes of interest included length of stay, pain, opioid consumption, postoperative nausea and vomiting (PONV), and inflammatory response. The results showed significant benefits in terms of reduced length of stay, pain, opioid consumption, PONV, and inflammatory response with perioperative steroids. High-dose steroids (>20 mg) specifically reduced inflammatory markers like C-reactive protein and IL-6 at 24 and 48 hours. These findings suggest that perioperative systemic steroids can enhance recovery without increasing postoperative complications in total hip arthroplasty.