70 patients (140 hips) undergoing primary bilateral simultaneous total hip arthroplasties (THA) underwent both minimally invasive and standard posterolateral techniques to compare surgical parameters, component positioning and safety. The type of procedure was randomly assigned to a side and the other procedures was performed on the contralateral side. The operative time and the duration of the hemovac suction drainage were significantly shorter in the minimally invasive group. Intraoperative blood loss, amount of hemovac suction drainage, hip scores, pain, range of motion, post-operative complication rate, and radiographic outcomes were similar between the two groups over the 24 month follow-up.