Forty-seven patients with hip osteoarthritis were randomized to receive either the direct superior approach (DSA; n=24) or the posterior approach (PA; n=23) for total hip arthroplasty (THA). The outcomes of interest included daily step counts, the Oxford Hip Score (OHS), Euro-QoL-5D (EQ5D), and pain and satisfaction, both measured on a visual analogue scale (VAS). Outcomes were assessed at 1-2 weeks, 2-6 weeks, and 6 weeks to 6 months postoperatively. Overall, the results of the study revealed no significant differences in step counts between the two approaches at any time point, although females in the DSA group had higher step counts than those in the PA group at 2 weeks (p=0.021), an improvement that was maintained at 6 weeks. This suggests that the DSA may be more beneficial for increasing postoperative activity levels in females.