Anterior hip replacement is a surgical approach that has dramatically changed the landscape of modern hip replacement. The approach is common to orthopedic trauma surgery, but it has been rapidly adopted in recent years for hip replacement as well. Its proposed benefits as a muscle-sparing surgery include less tissue trauma, faster recovery, and fewer hip precautions. While the technique can be challenging during initial learning and early adoption, the approach continues to increase in utilization in the U.S. every year because of these benefits. Understanding the initial development of the anterior surgical approach for hip replacement creates the foundation to better understand its modern clinical benefits and possibilities with advanced techniques. Furthermore, a detailed description of the reasoning behind the continued developments of the anterior approach helps in understanding the key elements needed to obtain the most successful outcomes.