The purpose of this investigation was to assess the midterm clinical outcomes after implantation of Oxinium (OX) vs cobalt-chrome (CC) femoral heads. Primary total hip arthroplasty (THA) procedures were performed in 100 patients. After randomization, half of the patients received OX femoral heads and half received CC femoral heads. At a minimum follow-up of 2-years, stem survival was 98% for both groups. The mean Harris Hip score was 92 for OX and 92.5 for CC, with mean WOMAC scores of 84.9 and 87, respectively. For SF-12, the OX group had mean physical and mental component scores of 45.2 and 53.8 and the CC group 49.2 and 52.6, respectively. At a minimum follow-up of 2 years, clinical outcomes for THA procedures using OX and CC femoral heads appear equivalent.