Fifty-six patients with femoral neck fractures sustained within a week and scheduled for a total hip arthroplasty (THA) via a direct anterior approach (DAA) were randomized to receive an anterior capsular pad to protect the tensor fascia lata muscle (TFLM), or a DAA THA without TFLM protection. The outcomes of interest included drainage volume, indicators of muscle damage (i.e. myoglobin, lactate dehydrogenase (LDH), creatine phosphokinase (CPK), mean change in fatty atrophy and muscle cross-sectional area (MCA) using MRI analysis), hemoglobin (Hb) levels, post-operative pain measured on a visual analogue scale (VAS), and function measured using the Harris Hip Score. All outcomes were evaluated pre-surgery and at 8, 24, and 48 hours post-surgery except for drainage volume (measured only at 48 hours post-surgery), fatty atrophy and MCA (measured before and after surgery), and the Harris Hip score which was evaluated at both 1 and 6 months post-operation. The results of this study revealed that all indicators of muscle damage were statistically significantly lower in the group with TFLM protection at 8, 24, and 48 hours post-operation (p<0.05 for all). Furthermore, mean change in fatty atrophy and MCA were also statistically significantly lower and in favour of the TFLM protection group (<0.05 for both). Serum Hb levels were statistically significantly higher in the group with TFLM protection at 24 and 48 hours follow-up (p>0.05 for both). Finally, Harris Hip Scores were statistically significantly higher at 1 month post-surgery in the group with TFLM protection (p<0.05), but this difference was not observed at 6 months post-surgery (p>0.05).