3 randomized controlled trials and 3 prospective cohort studies were included in this systematic review and meta-analysis comparing the posterior and direct lateral approaches to total hip arthroplasty. Rate of dislocation, Trendelenburg gait, incidence of heterotopic ossification, and functional outcomes were assessed. The results of this analysis demonstrated that the posterior approach to total hip arthroplasty yielded lower rates of postoperative limping and stem malposition. A non-significant reduction in the rate of dislocation and heterotopic ossification was also noted with the posterior approach. Due to the paucity of high quality evidence evaluating these procedures results should be interpreted with caution and further randomized control trials should be conducted.