60 patients between the ages of 18 and 60 years undergoing primary uncemented total hip arthroplasty (THA) for arthritis secondary to osteonecrosis of the femoral head were included in this prospective randomized controlled trial. Patients were randomized to undergo femoral canal preparation by either the posterior neck cortex trimming method (PNCT; n = 30) or by counter-clockwise rotation of starting awl (CCRA; n = 30). The outcomes of interest included angle of the femoral stem in the coronal and sagittal plane, femoral stem tip deviation in the coronal and sagittal plane, femoral anteversion/retroversion angle, femoral canal preparation time, and blood loss during the procedure. Study findings showed that while there was no significant difference between the groups with respect to coronal plane, the sagittal plane showed significant variation, with the mean angle of the femoral stem and the femoral step tip deviation being significantly lower in the PNCT group. Also, the number of patients with neutral femoral stem angle and femoral stem tip position was significantly higher in the PNCT group. with the CCRA group showing significantly higher posterior positioning for both measurements. However, patients in the CCRA group experienced less blood loss and had a significantly shorter duration of surgery.