Introduction <p>Total hip arthroplasty (THA) is a procedure primarily performed for hip osteoarthritis. Dislocation rates after primary THA range from 0.7 to 2%, remaining a key concern. Variability in surgical approaches, especially regarding posterior soft tissue repair, underscores the need for evidence specific to osteoarthritis. This review evaluates the impact of soft tissue repair on reducing dislocation rates in THA via posterior and posterolateral approach.</p> Methods <p>An exploratory systematic review was conducted to evaluate the effect of soft tissue repair on dislocation rates following THA for osteoarthritis. Studies in English and Spanish were included, focusing on posterior approach repairs. Searches were done in PubMed, Scopus, and Google Scholar. Three reviewers independently assessed study quality and extracted relevant data, using tools like APPRAISE-AI and PROBAST.</p> Results <p>Out of 478 initially identified publications, 13 studies met the inclusion criteria. The studies focused on the impact of soft tissue management on hip dislocation following THA in patients with osteoarthritis. Results consistently showed that preserving or repairing the external rotator muscles reduced dislocation rates, with tendon-to-bone repair proving most effective among the existing techniques for soft tissue and external rotator repair.</p> Conclusion <p>Soft tissue repair using the tendon-to-bone technique enhances hip stability and reduces the risk of dislocation in total hip arthroplasty for osteoarthritis. Preventive strategies should be tailored to individual risk factors, as personalized approaches are essential for optimizing outcomes in osteoarthritis patients with a high comorbidity burden.</p>