The anterior approach with a positioning table: First among equals

Direct anterior or Hueter approach (DA) is the only true muscle-sparing approach for total hip arthroplasty (THA) being purely internervous and intermuscular. Because this approach is executed in the supine position combined with the use of a dedicated positioning table, it allows for effective control of implant position. Although the DA can be done on a standard operating table, the use of a positioning table combines the advantages of facilitating femoral exposure as well as intraoperative imaging. Several studies of the DA have demonstrated more rapid recovery and return to unassisted ambulation without precautions, which is an attractive advantage for patients. Nevertheless, we strongly recommend following fellowship training or mentorship programs to minimize the initial learning curve with the anterior approach.