Leg length discrepancy (LLD) remains subject of ongoing debate regarding its significance and the clinical impact it has after total hip arthroplasty (THA). We aimed to assess the LLD causes and its impact on patient satisfaction after primary THA. Patients and Methods: This study was done at Menoufia University Hospital on 51 patients who had primary THA from December 2022 to December 2023. A pelvis anteroposterior X-ray was used to measure the preoperative and postoperative LLD. A computed tomography (CT) scanogram was used to measure true LLD precisely. Evaluation of patient satisfaction included the Harris Hip Score (HHS), the Oxford Hip Score (OHS), and a self-administered patient satisfaction scale. Results: The study included 51 patients, 24 males and 27 females, with a mean age of 49.5 years. Overall, 31 patients were very satisfied, 17 patients were somewhat satisfied, and 3 patients were somewhat dissatisfied. No one was very dissatisfied, according to the Likert scale. Conclusion: Understanding the elements of leg length assessment in THA is crucial for avoiding postoperative LLD and its associated complications. This involves comprehensive preoperative planning, precise intraoperative measurement, and vigilant postoperative management.