Objective Conversion total hip arthroplasty (CTHA) through a direct anterior approach (DAA) in supine position. Indications Failed osteosynthesis of proximal femoral fractures or failed conservative hip surgery, with hardware in situ. Contraindications Decayed general conditions, infection (peri-implant or systemic infection), need for greater trochanter reconstruction, severe proximal femur deformity. Surgical technique Supine position. Mark DAA and expected limited incisions for hardware removal (HR) with the help of a C-arm. Use guidewire and extraction devices for HR. Perform a DAA with particular attention to a wide release of the femur. Postoperative management Full progressive weight-bearing starting on day 1, depending on bone quality. Discharge with crutches following patient walking capability. Precautions for 6 weeks. Results In all, 27 conversion THAs through a DAA. Mean age at the time of surgery 59.8 (range 18–81) years. Mean body mass index was 23.5 (range 17–31.6). Reasons of previous surgery failures were avascular necrosis of the femoral head, posttraumatic arthritis and nonunion with or without hardware migration. Mean surgical time was 125.8 min (range 58–190 min, standard deviation SD 38.2 min). Mean follow-up time was 6.9 years (range 2–15, SD 5.03 years). Mean pre-Harris Hip Score (mHHs) was 24.4 (range 19–36, SD 5.4), while the mean post-mHHS was 90.3 (range 89–91, SD 0.95). Two patients required postoperative osteosynthesis for periprosthetic fractures due to falls. Overall complication rate was 10%.