Forty-five patients with end-stage hip osteoarthritis (OA) scheduled for a direct anterior approach total hip arthroplasty (THA) were randomized to receive an orthostatic retractor placement (ORP) for visibility during component insertion, or a handheld retractor placement (HHRP), with the surgery performed by a surgeon in the learning phase. Additionally, a control group was included in this study where an expert surgeon performed the surgery using an ORP device. Outcomes of interest included levels of C-reactive protein (CRP), hemoglobin, erythrocyte sedimentation rate (ESR), creatine kinase (CK), and lactate dehydrogenase (LDH) post-operation. Furthermore, other outcomes were operative time, tensor fascia lata damage, acetabular and femoral component alignment, Harris Hip Score (HHS), and Hip disability and Osteoarthritis Outcome Scores (HOOS) (i.e., pain, quality of life, activities of daily living, symptoms, sports). Biochemical outcomes were assessed up to 48 hours post-operation whilst functional outcomes were assessed up to 6 months post-operation. Results revealed that operative time was statistically significantly lower in the ORP group compared to the HHRP group (67 mins vs 50 mins; p<0.001); the expert ORP control group reported the lowest operative time of all groups with 34 mins. Moreover, CRP levels and hemoglobin levels were statistically significantly in favour of the ORP group at days 1 and 2 post-operation compared to the HHRP group (p<0.05 for all). Also, ESR levels were statistically significantly in favour of the ORP group (p=0.004). Significantly less tensor fascia lata damage was observed in the ORP and expert ORP groups compared to the HHRP group. No statistically significant differences between groups were observed in component alignment as well as HHS scores or HOOS scores at all time-points (p>0.05 for all).