We report our experiences with minimally invasive total hip replacement performed via a modified Watson-Jones approach with a special positioning technique (the "Stolzalpe technique"). With the patient placed in the conventional supine position, the contralateral leg is held in a gynaecological footrest to allow hyperextension, adduction and external rotation of the leg during femoral preparation. The first 117 patients operated with this technique were compared with a conventionally operated group. The patients operated with the Stolzalpe technique had superior results for nearly all study criteria, including time of operation, time of postoperative intensive care, blood loss, complications and Harris Hip Score. The Stolzalpe technique appears to be the best possible compromise between patient comfort and the surgical demands of proper implant positioning, minimization of anaesthetic risk, and reducing the time required for draping and positioning.