One hundred thirty-six patients without diabetes scheduled for total joint arthroplasty were randomized to receive either two perioperative saline injections (Group A, n=45, placebo), a single preoperative injection of 20 mg dexamethasone followed by a postoperative saline injection (Group B, n=46), or two perioperative injections of 10 mg dexamethasone (Group C, n=45). The primary outcome was postoperative fasting blood glucose (FBG) levels. Secondary outcomes included postoperative postprandial blood glucose (PBG) levels and postoperative complications within 90 days. Overall, the results revealed that both dexamethasone regimens led to transient increases in FBG and PBG on postoperative days 0 and 1, but no significant differences were observed between the two dexamethasone regimens. Neither regimen increased the risk of postoperative hyperglycemia. Elevated preoperative HbA1c levels were associated with an increased risk of postoperative hyperglycemia. The findings suggest that while dexamethasone transiently raises blood glucose levels, it does not lead to clinically significant hyperglycemia or increase postoperative complications.