Anterolateral minimally invasive hip surgery (ALMIS) is a challenging procedure that is thought to offer a more expedient and a better functional outcome. Seventy-nine patients receiving primary hip arthroplasty were randomized. Röttinger ALMIS technique was used for 42 patients, whereas 41 received the standard lateral transgluteal Hardinge approach. Operative time was longer with ALMIS (P = .000078), whereas blood loss was less (P = .008). Surgical and postoperative complication rates, morphine consumption, and length and cost of hospitalization were similar. At 1 year, Harris, Postel and Merle d'Aubigné, and Short Form-36v1 scores were similar. Gait analysis revealed similar results. Computed tomographic analysis revealed no significant difference in implant position, heterotopic ossification, and loosening. Röttinger ALMIS is a valid approach for hip arthroplasty. However, it offers no advantages at 1 year.