Total hip arthroplasty (THA) critically influences outcomes; however, a comprehensive mapping of the research landscape remains absent. We systematically characterized the knowledge structure, collaborative networks, and research priorities within the THA approach literature from 2000 to 2026. Multi-database bibliometric analysis integrated data from the Web of Science, PubMed, Embase, and Cochrane Library. Following deduplication, 4023 publications were analyzed using Bibliometrix, VOSviewer, and CiteSpace to map publication trends, collaboration networks, thematic evolution, and citation dynamics. Annual publications demonstrated sustained expansion (annual growth rate: 9.68% over the complete-year window 2000-2024), with marked acceleration after 2020 and peak production exceeding 300 publications during 2023 to 2024. The United States emerged as the primary hub (30.7% of publications), with European and East Asian centers forming secondary nodes. The Journal of Arthroplasty anchored volume (637 publications), while high-impact general journals (JBJS-Am, CORR) achieved the greatest citation efficiency (>60 citations per publication). Keyword clustering revealed well-differentiated themes ( Q = 0.351, S = 0.706) centered on outcome surveillance, direct anterior approach evaluation, and positioning accuracy. Citation bursts documented a 3-phase evolution: minimally invasive descriptions (2003-2012), comparative benchmarking (2012-2020), and registry-based evidence (2018-2026). The field has matured from seeking universal approach superiority toward patient-, surgeon-, and system-specific selection paradigms. Priority directions include implementation science for learning curves, standardized patient-centered outcomes, health economic assessment, and approach-technology-pathway interaction studies. Geographic expansion beyond North American and European centers is essential for evaluating context-dependent effectiveness across diverse healthcare systems worldwide.
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