Background: When an innovative method is used for primary total hip arthroplasty (THA), the patient has the best chance of benefiting from primary surgery, particularly in terms of stability and durability. Aim: To compare results of THA for patients with hip osteoarthritis via direct anterior approach versus direct lateral approach regarding short term clinical and functional outcomes and evaluation of complications. Methods: This randomized controlled clinical trial was conducted at Department of Orthopedic Surgery, Zagazig University on 36 patients, 18 in each group as follow: Group A: was treated with THA through direct anterior approach (DAA) and was called (DAA group) and Group B: was treated with THA through direct lateral approach (DLA) and was called (DLA group). Results: There was significant difference as regard operation time (longer in group A). There was significant difference as regard blood loss and need for blood transfusion postoperatively (increased in group B). There was highly significant difference between groups as regard discontinuation of use of frame and cane/crutches. There was significant difference between groups as regard recorded HHS at one and 3 months postoperatively with no significant difference between both groups as regard recorded HHS at 6 months postoperatively. Conclusion: While the long-term follow-up results seem to indicate that the expected outcomes are comparable to other traditional approaches, the DAA was demonstrated in this study to offer the potential benefits of reduced muscle injury, a shorter hospital stay, a faster return to work and activities, and a lower dislocation rate.