A retrospective review of 770 consecutive primary total hip arthroplasties was conducted to determine the complications and utility of a modified direct lateral approach, which involves elevation of the anterior one-third of the gluteus medius and vastus lateralis in continuity. In 640 patients, 712 total hip arthroplasties were followed up for a minimum of 2 years (maximum 6.5 years, average 3.6 years). Two prosthetic dislocations occurred in the follow-up period, for a prevalence of instability of 0.3%. A moderate or severe limp was present in 10% of all patients at 2-year follow-up and in 4% of a subgroup of patients with only unilateral osteoarthritis of the hip (Charnley A). Severe heterotopic ossification (Brooker grade III or IV) developed in fewer than 3% of hips and was functionally limiting in only seven patients. Four sciatic nerve palsies occurred. Surgical exposure has been excellent through this approach, without the need for extensile measures, such as a trochanteric osteotomy. The duration of surgery has been considered acceptable, and the position of the components considered excellent while using this approach. From this review, it was concluded that this modified direct lateral approach has greatly diminished the potentially devastating complication of postoperative instability and is associated with an acceptable level and severity of limp and heterotopic ossification. The approach provides excellent exposure in primary total hip arthroplasty to allow accurate placement of components in an efficient manner.