49 patients scheduled for hip resurfacing were randomized to either an anterolateral approach or posterior approach. Patients were assessed for component migration on radiostereometric analysis over 2-year follow-up, as well as periprosthetic bone mineral density, clinical results, and incidence of radiolucency and osteolysis. Total translation and rotation of the acetabular component was significantly greater at 3 months in the anterolateral approach group compared to the posterior approach group; differences at 2 years were not statistically significant. The anterolateral approach also demonstrated lower measures for femoral bone mineral density in the central medial region of interest at 1 and 2 years when compared to the posterior approach group. Differences between groups in Harris Hip Scores and visual analog scale (VAS) pain scores were not significant.