The early results of minimal incision surgery (MIS) were compared with those of the standard procedure using the Revelation Hip System (DJO Surgical). From June 2004 to December 2005, 40 primary total hip arthroplasties (38 patients) were performed. In the 40 hips, 22 hips underwent MIS (initial skin incision of less than 10 cm) and 18 hips underwent the standard procedure. At the final investigation, 21 hips from the MIS group and 17 hips from the standard group were followed up. The average follow-up was 41 months (3452 months). Two surgeons (YT, NW) performed all surgeries in this series. All operations were started with the MIS procedure (initial skin incision of less than 10 cm), but when the surgeons considered it was impossible or not suitable to continue the MIS approach during the operation, an additional skin incision and soft tissue release were applied. Each surgeon decided whether MIS was appropriate for each patient or not. The antero-lateral approach (modified Dall) was used for all surgeries. The same rehabilitation program was used for both groups postoperatively. The applicability of MIS was significantly less in male patients (males: 2/8, females: 20/32). There was a correlation between patients height and the length of skin incision (p < 0.05). No significant differences between the two groups were found in CRP, CPK and D-dimer (CRP: 14.2/12.5 mg/dl, CPK: 396.7/368.1 mg/dl, D-dimer: 14.2/5.2 mg/dl). Both intraoperative blood loss and operation time were less in the MIS group (blood loss 529.4 ml vs. 766.7 ml, operation time 101 min vs. 115 min). The postoperative days until the patient was able to do active straight leg raising (SLR) were 17.4 in the MIS group and 22.8 in the standard group, and number of days in hospital was 22.6 versus 29.2, respectively. However, no significant differences with duration of hospitalization were found statistically. On radiographic findings, the lateral inclination of the acetabular cup was 42.7 in the MIS group versus 40.9 in the standard group, showing no significant difference (p = 0.459). The hip score according to the Japanese Orthopedics Association (JOA) was not significantly different between the two groups at the final follow-up (88.1 in MIS group, 85.9 in standard group). At 3, 6, 12, 18, 24 and 30 months after operation, JOA hip scores were not significantly different between the two groups. There were no revision cases in this study until the final follow-up. In the present study, intra-operative hemorrhaging and operation time were significantly less in the MIS group. However, for the other parameters, no significant differences were found in the laboratory data, radiographic findings, hospitalization, or JOA scores.