125 patients were randomized to use of either fluoroscopy or imageless navigation for the placement of a total hip arthroplasty (THA). The purpose of the study was to investigate whether use of imageless navigation improves accuracy, increases precision or reduces outliers in leg length and global/femoral offset restoration when compared to fluoroscopy in THA via anterolateral approach. Results revealed that fluoroscopy and navigation did not significantly differ with respect to accuracy of leg length and overall offset. However, significant difference was evident in precision between groups for leg length, and global/femoral offset (absolute difference between preoperative plan and postoperative result), with increased precision noted in the navigation group. The rate of outliers outside 5mm deviation for leg length, global offset, and femoral offset was higher in the fluoroscopy group than the navigation group for all three parameters. Groups were similar when considering outliers at a benchmark of 8mm.