Abstract Objective To study the clinical effect of total hip arthroplasty with direct anterolateral approach and anterolateral approach. Method From May 2015 to may 2019, the clinical data of 128 patients who underwent primary unilateral total hip arthroplasty in our department were analyzed retrospectively, including 65 patients with anterolateral approach(AL group) and 63 patients with direct anterior approach(DAA group) a. Results (1) there was no significant difference between the two groups in gender, age, side, BMI, etiology and other baseline data (P > 0.05).(2) the incision length, intraoperative blood loss, postoperative hidden hemorrbage and walking time of patients in DAA group were significantly less than those in AL group, while the operation time in DAA group was significantly longer than that in Al group (P < 0.01).(3) the level of C-RP and ESR in DAA group was significantly lower than that in AL group (P < 0.01).(4) the VAS score of the two groups was significantly lower than that of AL group on the first day after operation (P < 0.01). At the first month and third month after operation, the Harris score of DAA group was significantly better than that of AL group (P < 0.01). (5) there was no significant difference in abduction angle and anteversion angle of acetabulum (P > 0.05).Conclusion In the primary total hip replacement, the direct anterolateral approach is better than the anterolateral approach. Although the learning curve is long, it has the advantages of less trauma and less complications.