Patients without prior hip surgery and body mass index lower than 30 undergoing primary total hip arthroplasty were eligible to participate in a randomized prospective study comparing a minimally invasive with a standard approach. The patients were randomized to receive incisions of 8 cm (group A, n = 28) or 15 cm (group B, n = 32). The groups were similar demographically. Patients in group A had significantly less intraoperative blood loss (P < .003) and less total blood loss (P < .009). Fewer patients in group A limped at 6 weeks (P < .04). Operative time, transfusion requirements, narcotic usage, length of hospital stay, achievement of rehabilitation milestones, cane usage, and complications were similar in both groups. There was no difference between the groups at 1- and 2-year follow-up. Compared with a standard incision, patients who underwent a minimally invasive total hip arthroplasty demonstrated decreased blood loss and limped less at 6-week follow-up.