Excellent long term results in total hip arthroplasty (THA are achievable through a variety of surgical techniques. However, the push for cost savings and higher patient expectations has shifted the focus to improving short term outcomes such as length of stay and in-hospital narcotic requirements. While approximately 87% of surgeons worldwide continue to prefer traditional posterolateral (PL) or lateral approaches for arthroplasty, 1 alternative approaches that spare the iliotibial band have emerged over the last several years in hopes of improved outcomes. This review explores the iliotibial band-sparing approaches, their advantages and disadvantages, and provides an overview of their published results.