100 patients scheduled for total hip arthroplasty were randomized to either a direct anterior approach or a direct lateral approach. Patients were assessed for early and midterm outcomes with respect to pain, function performance, and patient-reported functional measures, as well as the incidence of complications. Results demonstrated significant advantages of the direct anterior approach relative to the direct lateral approach with respect to pain and narcotic consumption 2-3 days after surgery, functional performance at 3 days after surgery, and patient-reported function at 8 weeks after surgery. Nonetheless, midterm outcome for these measures did not significantly differ between groups, and the incidence of approach-related complications within the first 5 years was significantly higher among the direct anterior approach group.