17 studies, including 2 randomized controlled trials, were selected for this systematic review and meta-analysis comparing the efficacy of anterior approach primary total hip arthroplasty to posterior approach. This review was conducted in order to evaluate and compare surgical and clinical results between these two approaches. The results of this study indicate that the anterior approach offered greater progress in pain, function, ability to walk, and narcotic ingestion, as compared to the posterior approach. No significant differences were noted in other variables, including estimated blood loss, rate of intraoperative fractures or recovery of gait.