OBJECTIVES: MIS THA techniques have shown treatment advantages over conventional THA – particularly in terms of reduced hospital stay and rehabilitation time – key issues influencing the costs of THA. However, relatively few economic studies have been conducted in this area. METHODS: Cost data from 224 patients, 140 undergoing MIS hip procedures and 84 undergoing conventional THA in two German orthopaedic centres were analyzed. Actual costs associated with MIS and conventional THA were compared, including staff, hospital overheads and general costs. Differences in costs of prosthetic hip implants were identified as a potential source of bias and were therefore excluded from calculations. Comparisons across 12 quality indicators were made between THAs conducted in one German hospital with the MIS technique, and the overall German average from 2006 (published by the German Federal Office of Quality Assurance [BQS]). RESULTS: MIS technique was associated with 28.5% lower total costs than conventional THA. Cost savings were predominantly due to shorter duration of hospital stay, shorter operation time, shorter post-operative care, and associated lower costs for nurses, physiotherapists and overheads. The two patient populations in the cost analysis had similar baseline demographics. Regression analyses showed that 84% of the difference between the two samples was an effect of surgical technique; 16% might be caused by age and gender (R2=0.67). Level of experience of surgeons was also identified as a possible bias but no variance was observed. Quality comparison of the MIS technique in the hospital performing MIS THA with overall data from the whole of Germany showed that 10 to 12 quality indicators favoured the MIS technique. There were no post-operative wound infections in any of the MIS THA procedures. CONCLUSIONS: This recent German cost comparison study demonstrates the treatment and economic advantages provided by the range of MIS techniques over conventional THA.