〔Abstract〕 Objective To evaluate and analyze the clinical effi cacy of patients undergoing total hip arthroplasty using direct anterior approach (DAA) and posterior approach (PA). Methods A total of 60 patients who were diagnosed and treated with femoral ischemic disease, hip dysplasia, and hip osteoarthritis from the fi rst people's hospital of Zhaoqing from June 2018 to June 2019 were collected, and 30 patients were randomly assigned as DAA surgery group. The other 30 patients were in the PA surgery group. Comparison of surgical time, intraoperative blood loss, postoperative drainage, Harris hip score (HHS), the western Ontario and McMaster universities osteoarthritis index (WOMAC) and postoperative satisfaction were compared between these two groups. Results Sixty patients were followed up for an average of 6 months. There was no signifi cant difference in surgical time, and 6 months postoperative VAS score between the two groups (P > 0.05). Compared with the PA group, the DAA group had less postoperative drainage, and the HHS score and WOMAC score at 6 months after surgery were more advantageous, and the differences were statistically signifi cant (P < 0.05). Conclusion The early curative effect of DAA is satisfactory, and it has the advantages of less hip tissue damage, less bleeding, short recovery time, and early return to daily activities. Favored by surgeons and patients.