For this study, 100 total hip arthroplasties (THAs) in a transtrochanteric approach group and 100 THAs in a posterolateral approach group were performed at one university hospital by a single, experienced surgeon. These THAs were then followed up for a minimum of 2 years to determine the incidence of postoperative complications. In our study, patients undergoing primary THA by the posterolateral approach were 18.4 times more likely to be complication free than patients in whom the transtrochanteric approach was used. This benefit, combined with a shortened surgical time, decreased blood loss, and technical ease, shows the advantages of the posterolateral approach for THA.