One hundred twenty-seven patients undergoing outpatient total hip arthroplasty with the direct anterior (DA) approach were prospectively randomized and compared to fifty-one patients undergoing outpatient total hip arthroplasty with the direct lateral (DL) approach. The primary outcome of interest was the overall cost from a Canadian healthcare payer perspective. Secondary outcomes included costs from a societal perspective, encompassing patient-incurred costs, productivity losses, and informal care. Cost data were collected during hospitalization and via patient-reported diaries after discharge. Overall, the results of the study revealed no significant differences in healthcare payer costs (DA: $7910.19 vs DL: $7847.17, p=0.80) or societal costs (DA: $14657.21 vs DL: $14581.21, p=0.96). These findings suggest that the choice of surgical approach does not influence overall resource use in successful outpatient hip arthroplasty cases.