Five hundred thirty-five patients undergoing elective primary Total Hip Arthroplasty (THA) were randomized to cutaneous closure with staples (n=268) or sutures (n=267). The primary outcome was SSI (<6 weeks). Secondary outcomes included prosthetic joint infection (PJI, <1 year), other wound complications (prolonged discharge, dehiscence, necrosis; <6 weeks), and length of stay. Outcomes were assessed during admission, at discharge, then at 2 weeks (removal), 6 weeks, 3 months, and 1 year. Overall, the results of the study revealed a higher—nearly significant—SSI rate with staples and a clearly higher rate of early wound complications, driven by prolonged discharge; PJI did not differ. These findings suggest sutures should be preferred for skin closure after THA.