Total hip arthroplasty (THA) can be safely performed through a number of surgical approaches. The classic direct anterior approach to the hip first was described by Smith-Peterson and then modified and used by different surgeons for THA. In theory, the direct anterior approach offers the only path to performing minimally invasive THA in an intermuscular plane without muscle detachment from bone. The most common anterior approach used today for THA is the Hueter approach; however, this approach has been associated with a higher incidence of lateral femorocutaneous nerve (LFN) damage. A modified Hueter approach was later described with a more lateral incision to decrease LFN damage. Custom instrumentation and a dedicated orthopedic table are needed to perform this procedure to allow visualization and prevent excessive trauma and traction on the soft tissues. This video demonstrates the surgical technique of modified minimally invasive direct anterior THA, which is key to the success of these procedures. The major limitations of traditional anterior approaches for THA include a high incidence of LFN damage, difficult visualization of the femur with a high incidence of femoral fractures, and a difficult orientation of the acetabular component. An incision 2 cm distal and 2 cm lateral of the anterior superior iliac spine in the direction of the lateral epicondyle of the distal femur extended for 6 cm to 8 cm is suggested to reach the anterior-medial part of the tensor fasciae lata. The fascia is incised and detached superiorly and medially to achieve the intermuscular space without damaging the LFN. Dedicated instrumentation and an orthopedic table are mandatory for correct exposure of the acetabulum and the femur. Dedicated reamers and femoral broaches with an offset reduce the incidence of complications such as cup malpositioning and femoral fractures.The modified minimally invasive direct anterior THA provides good access to the acetabulum and femur and preserves the hip muscular attachments with no hip dislocation. This approach improves control of acetabular cup positioning and leg length while allowing for surgery with low blood loss, few complications, and a short hospital stay.