The authors of this study randomized 164 patients to direct anterior (DAA) or direct lateral approach for primary total hip arthroplasty. Patients and outcome assessors were blinded. They assessed radiographic outcomes on the immediate post-operative X-ray. Outcomes included cement mantle thickness, cup positioning (inclination and anteversion), femoral stem position (on AP and lateral views), offset, and leg length discrepancy. There were no significant differences in terms of femoral component positioning, offset, or leg length discrepancy. The cement mantle in Zone 1 was significantly thicker in the DAA group, and the acetabular component was significantly more anteverted and had significantly greater inclination.