 From Hookstown northbound, PA 168 originally ran up Main and Hill Streets through Georgetown to Smith's Ferry which was used to cross the Ohio River to join the route's northern segment on Smith's Ferry Road in Ohioville.Both segments leading to the Ohio were later relocated.In 1946, the entire Smith's Ferry Road segment from the north was moved east onto Fairview Road and continued southbound onto Midland Avenue, forming a concurrency with PA 68 through Midland to Cooks Ferry in Industry.