Total hip arthroplasty (THA) is a major procedure that plays an important role in relieving pain and restoring function in end-stage hip related diseases, and the number of THA procedures continues to grow at a high rate. Unfortunately, there is no guideline or expert consensus on the choice of THA approach in China or abroad. Therefore, to formulate the clinical practice guidelines for THA approach selection based on evidence-based medicine is of major importance. The guidelines were developed by the Joint Surgery Group of the Orthopaedic Branch of the Chinese Medical Association and Chinese Journal of Joint Surgery (Electronic Edition) and were designed and developed in accordance with the World Health Organization Manual for the Development of Guidelines and the Basic Methods and Procedures for the Development/Revision of Clinical Guidelines. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist were adopted. Finally, 11 clinical questions were selected, resulting in 11 evidence-based medical recommendations. The guidelines are intended to guide the clinical practice of a wide range of relevant healthcare professionals in relation to surgical approach selection and to normative guidelines for a good prognosis for patients with THA.