70 patients scheduled for total hip arthroplasty were randomized to either the direct anterior approach or the direct lateral approach. Patients were followed up for biomarkers of muscle damage (myoglobin, creatine kinase, and lactate dehydrogenase), surgical outcomes including operative time and blood loss, pain and pain management outcomes, and complication rates. The only significant difference in biomarkers observed between groups was a smaller increase in myoglobin at 24 hours in the DDA group. Operative time for the series was on average significantly longer in the DAA group. Blood loss measures did not significantly differ between groups. Pain scores for postoperative day 1 and perioperative opioid consumption were significantly lower in the DAA group.