Although no proven evidence exists for the use of drainage in primary total hip arthroplasty, such drainage is routinely used. This prospective, randomized study comprised 80 patients who underwent a non-cemented total hip arthroplasty using a minimally invasive anterolateral approach. Patients were divided into 2 groups of 40: group 1 underwent drainage treatment and group 2 underwent no drainage treatment. No selection of patients occurred by age, sex, or body mass index. Blood loss was not significantly different between groups 1 (mean blood loss, 0.9 L [range, 0.3-2.1 L]) and 2 (mean blood loss, 0.9 L [range, 0.3-2.4 L]) (P=.7). On postoperative day 1, patients who underwent drainage treatment reported significantly more pain at rest (P=.01) and under stress (P=.03). The same finding was observed on postoperative day 4 (at rest, P=.04; under stress, P=.02). The nonuse of drainage significantly reduced operative time by 72 seconds (P=.01). Patients without drainage treatment had significantly larger hematomas than patients with drainage (mean, 43.7 cm(2) [range, 0-343 cm(2)] vs mean, 40.1 cm(2) [range, 0-514 cm(2)], respectively) (P=.03). No clinically relevant benefits associated with the use of drainage were identified. The increased size of the hematoma was not reflected in patient comfort. The authors consider the use of drainage in primary total hip arthroplasty unnecessary.