Modern advances in total hip arthroplasty have included improved biomaterials, alternative bearings, so-called fourth-generation cement techniques, and enhanced in-growth prostheses. Recently, much attention has been focused on improving the surgical technique for total hip arthroplasty. This endeavor has included the development of mini-incision arthroplasty and has now progressed to minimally invasive procedures. Minimally invasive techniques are modified versions of the classic approaches to the hip, with the goal of decreasing soft tissue dissection and trauma. While these new surgical exposures may result in improved short-term outcomes, their long-term results have yet to be proven. In addition, they are technically demanding, may require specialized training, and can be associated with a difficult learning curve. Only the future will determine if mini-incision and minimally invasive arthroplasty are as successful as the well-proven standard surgical approaches used for the last three to four decades.