Robert Judet first performed hip arthroplasty via the anterior approach (AA) in 1947 on an orthopaedic table. Our center has a near 20-year experience on more than 3500 patients operated by AA hip arthroplasty. While primary AA total hip arthroplasty techniques have been discussed in the literature, revision AA total hip arthroplasty techniques are relatively new. The current article in the Journal's "Safe Surgical Technique" series describes the successful application of an adjunctive iliac osteotomy to improve femoral exposure in two selected patients undergoing AA revision hip arthroplasty. The potential risk/complications of an iliac osteotomy include iatrogenic fracture, malunion/nonunion, infection, and pain. These potential risks should be weighed against the potential benefits of improved surgical exposure and/or risks of other revision techniques. Future prospective longitudinal studies will be helpful to determine efficacy and risk profile compared to other revision techniques.