Fifty patients with osteoarthritis were randomized to receive either the anterior approach (AA) with intraoperative fluoroscopy (n=23) or the posterior approach (PA) without intraoperative imaging (n=25) for total hip arthroplasty (THA). The outcomes of interest included the accuracy of component placement (measured by acetabular anteversion, acetabular inclination, femoral version, and combined anteversion), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and EuroQoL-5D (EQ5D) score. Scans used to assess implant positioning were completed preoperatively and again at 3 months, and patient-reported outcome scores were assessed at 1-year follow-up. Overall, the results of the study revealed no significant differences between the two groups in terms of implant positioning. While the AA with intraoperative fluoroscopy led to a narrower range of implant positions, it did not significantly improve accuracy over the PA.