Fifty-five patients with osteoarthritis or osteonecrosis scheduled for a total hip arthroplasties (THA) were randomized into receiving THA via the direct anterior approach (n=28) or posterior approach (n=27). The primary outcome of interest included the hospital length of stay. The secondary outcomes included function measured by Harris Hip Score (HHS), pain measured on a Visual Analogue Scale (VAS), implant position, complications, and surgical time. HHS and VAS scores were measured pre-operatively as well as at 2 weeks, 4 weeks, 3 months, 6 months, 1 year, 2 years, and 5 years post-operatively. The remaining outcomes were measured at 5 year follow-up. The results of the study demonstrated that the primary and secondary outcomes were not statistically significantly different between the 2 treatments, except for surgical time which was in favour of the posterior approach (p=0.002).