The (R)evolution of the anterior approach to the hip joint

The anterior approach to the hip joint has evolved from a broad, muscle-detaching exposure used for resections in the late 19^th century to a refined, muscle-sparing technique, now widely employed for total hip arthroplasty (THA) and hip-preserving procedures. This review synthesises the surgical, technical, and conceptual developments that have shaped the modern anterior approach, with emphasis on contemporary refinements relevant to arthroplasty practice. Historical and technical literature, spanning from the original descriptions (Roser, Lücke, Hueter) to 20^th and 21^st century innovators (Kocher, Smith-Petersen, Levine, the Judets, Laude, Keggi, Matta, Berger, Leunig, and others), was synthesised to delineate chronological advances in exposure, femoral preparation, implant insertion, perioperative management, and cosmetic or ergonomic modifications. This review focused on changes that reduced soft-tissue injury, found solutions to femoral exposure challenges, and the introduction of adjuncts such as traction or positioning tables, intraoperative fluoroscopy, and navigation. The anterior approach has transitioned from a resection technique to a contemporary, muscle-sparing, inter-nervous approach for total hip arthroplasty (THA). Historical advances and modern refinements now enable reproducible acetabular and femoral procedures including revision arthroplasty, providing potential benefits in early recovery and cosmetic outcomes.