Two hundred and nineteen patients undergoing total hip arthroplasty (THA) were randomized to receive surgery with a short incision or a standard incision (16 cm). Over 6 weeks, there was no difference between the two groups for clinical outcomes, functional tests, radiographic parameters, change in scar length, and swelling. However, the standard incision group had greater intraoperative blood loss than the short incision group. Overall, there appeared to be little difference between the two THA techniques and the minimally invasive technique was deemed to be just as safe and effective as the standard method when performed by a high volume hip surgeon with experience in minimal incision techniques.