Inclusion Criteria:  Symptomatic osteoarthritis of the hip indicating primary total hip arthroplasty Aged 21 years or older Patients willing and able to comply with follow-up requirements and self-evaluations Ability to give informed consent Body mass index ≤45 kg/m2  Exclusion Criteria  Active or prior infection Medical condition precluding major surgery Medical condition with less than 2 years life expectancy Overhanging pannus (for anterior approach cohort only) Prior surgery of the hip involving implantation of hardware (i.e., hemiarthroplasty, internal fixation, pelvic reconstruction near the acetabulum requiring removal) Skin condition on the area of incision Multi-level lumbar spine fusion Ankylosing spondylolithesis Shortening osteotomy through the femur