T he direct anterior approach for THA has garnered substantial interest among total joint surgeons. A Google search for ‘‘anterior approach hip’’ returned 1,190,000 matches. The most common claims of superiority of direct anterior approach include: Decreased length of hospital stay, quicker rehabilitation, less blood loss, shorter surgery, less postoperative pain, lower risk of dislocation, more natural return to function and activity, and shorter incisions. In fact, one manufacturer’s website (http://www. aboutstryker.com/hip/procedures/procedures-daa.php) emphasizes that the new approach can be done through a three or four inch incision, compared to eight to 12 inches for a moretraditional approach, which the manufacturer also says ‘‘requires a significant disturbance of the joint and connecting tissues.’’ Ironically, direct anterior is considered a new approach even though the anterior approach (which is the lower limb of a classic Smith-Peterson approach) was described in 1949 and was used during my residency training and musculoskeletal oncology training (1979–1986). The approach was recommended for patients with higher risk of dislocation (dementia, neuromuscular disorders) and was used for treatment of benign and malignant disease of the hip. In practice, I have also used it in cases of simultaneous bilateral THA.