Three randomized controlled trials (288 patients) comparing tranexamic acid (TXA) + dexamethasone (DEX) against TXA alone in patients undergoing total hip or knee arthroplasty were included in this systematic review and meta-analysis. The primary outcome of interest was the incidence of oxycodone use. Secondary outcomes included total blood loss, the incidence of postoperative nausea and vomiting (PONV), the incidence of metoclopramide use, range of motion, length of stay, incidence of transfusion, and the incidence of adverse events. Oxycodone use, incidence of PONV, metoclopramide use, and length of stay were significantly lower in the TXA+DEX group compared to TXA alone, with a significantly better range of motion. The use of TXA+DEX was shown to significantly improve intra- and postoperative outcomes in patients undergoing total hip or knee arthroplasty.