Dislocation is a leading early complication of total hip arthroplasty. The effect of surgical approach on instability and abductor function is a controversial topic. A comprehensive literature review was done to evaluate the correlation of surgical approach and primary total hip arthroplasty dislocation. Two hundred sixty clinical studies were identified between 1970 and 2001. Four prospective studies were identified but individually they contained insufficient power or control groups to reach statistical significance regarding surgical approach and dislocation. Fourteen studies involving 13,203 primary total hip arthroplasties met the inclusion criteria based on variables previously shown to affect stability. These studies were evaluated with respect to surgical approach and dislocation. The combined dislocation rate for these studies was 1.27% for the transtrochanteric approach, 3.23% for the posterior approach (3.95% without posterior repair and 2.03% with posterior repair), 2.18% for the anterolateral approach, and 0.55% for the direct lateral approach. Eight studies involving 2455 primary total hip arthroplasties evaluated postoperative limp. The incidence of postoperative limp was 4% to 20% for patients who had the lateral approach and 0% to 16% for patients who had the posterior approach. The quality of the literature regarding surgical approach, dislocation rates, and abductor function is limited. Larger controlled prospective studies are needed to investigate the potential benefits of the posterior approach in lieu of a dislocation rate six times higher than the direct lateral approach for primary total hip arthroplasty.