This study directly compared a minimally invasive dual-incision muscle-sparing surgical technique with a standard posterolateral approach in total hip arthroplasty to assess for early complications, clinical success, and alignment. Total hip arthroplasties using a minimally invasive, muscle-sparing, dual-incision approach were performed on 21 hips (20 patients). This cohort was compared to a contemporaneously performed group of 21 hips (20 patients) using a standard posterolateral approach. Five complications were reported for the dual-incision group versus one complication for the posterolateral group. Postoperative radiographic alignment of the prosthesis was closer to optimal for the posterolateral group. The dual-incision group had longer operating times and a significant increase in complications. The authors have discontinued the use of this technique based on the results of this study.