Total hip arthroplasty is an exceptionally cost-effective and successful surgical procedure. Dislocation, infection, osteolysis, and limb-length inequality are among the most common complications affecting the long-term success of total hip arthroplasty. Instability is a challenging complication to treat. The surgeon frequently must try to achieve a stable hip at the cost of increasing the length of the operated extremity. It is important to understand the factors associated with stability and limb length; the surgical options available; the effect and role of the various surgical approaches; and methods to manage instability, with and without limb-length inequality.