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The single-incision minimally invasive anterior approach to the hip with complete preservation of the musculotendinous structures offers excellent surgical exposure of both the acetabulum and the femur for the purpose of total hip replacement. Acetabular exposure corresponds to a modified and limited Smith-Petersen approach with intrinsic peculiarities. Femoral exposure in external rotation, adduction and extension of the leg is unusual for replacement purposes and is accomplished by the use of a traction table and a specially designed hook. Anterior single-incision exposure combines the advantage of intrinsic articular stability of anterior approaches with the advantages of preservation of lateral pelvitrochanteric and posterior myotendinous structures. An adequate learning curve must be overcome due to peculiar adaptations during the course of operation. A large variety of femoral components may be implanted by this approach; metaphyseal anchoring stems and femoral neck-preserving stems are particularly suited to this technique, combining both issues of minimally invasive surgery in total hip replacement: bone preservation and minimal surgical invasiveness. This article describes the surgical technique that we adopted in 2003 and compares it to other minimally invasive surgical techniques. [ABSTRACT FROM AUTHOR]