The anterior approach for bilateral total hip arthroplasty uses live fluoroscopic imaging and supine patient positioning, which afford improved access to both hips without intraoperative repositioning. This video reviews the literature on and history of bilateral total hip arthroplasty. We present set up and draping for, limb-length and offset re-creation for, and a live demonstration of bilateral total hip arthroplasty via the anterior approach, discussing preoperative and postoperative radiographs and outcomes.