Prosthetic dislocation is a devastating complication after hip hemiarthroplasty. Posterior and anterior approaches were compared in 375 patients over a 10-year period to determine the effect of surgical approach on the rate of dislocation at 6-month follow-up. Nine (2.3%) dislocations occurred in the study population--all in the posterior group (4.5%, P < .0033). Length of stay, discharge disposition, and cognitive impairment were also compared between the two groups. In this series of proximal femoral fractures treated with hemiarthroplasty, an anterior capsular approach is associated with increased stability.