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Total hip arthroplasty is a successful procedure for treatment of painful hip arthritides. A large volume of literature is devoted to the patient outcomes and complication profiles of the commonly used surgical approaches to help refine the technique, enhance patient function, and limit cost and patient morbidity. The direct anterior approach has been reported using a fracture table to promote surgical exposure to the proximal femur. This technique is described herein with attention paid to the technical points which facilitate surgical exposure, patient safety, and functional outcome. Following a literature review of recent reports using this procedure are reviewed in context of the reported complications. The results show the direct anterior approach using a fracture table performed by experienced surgeons is an effective technique which provides early postoperative function and reduces the risk of dislocation.