Total hip arthroplasty (THA) is one of the commonly performed surgeries in orthopedics. THA is performed for various indications like end-stage degenerative hip osteoarthritis (OA), hip osteonecrosis (ON), congenital hip disorders, post-traumatic arthritis of hip, inflammatory arthropathies of hip. It is done for pain relief, functional restoration and overall improvement in quality of life. Hip osteoarthritis (OA) is the most prevalent and disabling conditions affecting the elderly. There is an estimated 25% lifetime risk of symptomatic hip OA in people who live to age 85 years.

          There are 3 classic approaches for THA, each with advantages and disadvantages: the Direct Anterior Approach, the Posterior Approach and the Lateral Approach.

           The direct anterior approach to the hip was originally described by Carl Heuter in 1881. Smith-Peterson had frequently used this approach and modified over the years and popularized this approach in 1920s-1930s. The anterior-based incision utilizes the interval between the tensor fascia lata and the sartorius muscles. The main advantage of the approach to be the muscle-sparing nature, earlier restoration of gait kinematics and low dislocation rates. The direct anterior approach can be performed with or without the use of a specialized table. Main challenges in anterior approach is limited exposure, difficulty in obese patient, and duration of surgery increases due to limited exposure, also it has steep learning curve.

             The posterior approach to the hip was popularized by Moore in the 1950s. The posterior approach is the most common surgical approach used globally for THAs. It provides adequate visualization of both the acetabulum and femur during both reconstructive procedures. The approach spares the abductor muscles during surgical exposure of the acetabulum and femur. Main drawback of posterior approach was dislocation due to cutting of short external rotators of hip. However, dislocation became less common with the PA because of enhanced capsular closure and larger heads.

              The direct lateral approach to the hip was described by Hardinge in 1982. This approach provides adequate exposure of both the proximal femur and acetabulum. It has the benefit of providing an extensive exposure to the femur as required. A very low dislocation rate has also been reported in clinical follow-up. However main drawback of this approach is abductor weakness as we split abductors of hip.