Abstract: Objective: To analyze femoral fracture and related risk factors in direct anterior approach for total hip arthroplasty in lateral position. Method: A consecutive series of 261 patients by DAA in Lateral Position from January 2018 to January 2020 were analyzed. The surgery were performed with conventional operation bed and stem. The correlations between incidence of fracture with gender, age, BMI, height, osteoporosis, ASIS-GTD, and hip diseases were analyzed by using univariate analysis and logistic regression analysis. Results: 34 cases had femoral fractures, of which 29 were greater trochanter fracture, 4 were proximal femoral splits, 1 was femoral perforation. The incidence of fractures was 13.03%. Univariate analysis shows: the discrepancies in incidence of fracture among gender, BMI and age were not statistically significant. The incidence of fracture declined as the height increased; Osteoporosis caused an increase in the incidence of fracture; ASIS-GTD expanded, the incidence of fracture descended; The incidence of femoral neck fracture and osteonecrosis of femoral head was lower than others (P<0.05). Logistic regression results showed that there was a significant correlation between osteoporosis , ASIS-GTD and incidence of fracture (P＜0.05). Patients with osteoporosis had a high possibility of fracture (OR=2.353). The possibility of fracture decreased with an upward ASIS-GTD. For each additional unit (mm) of ASIS-GTD, the possibility of fracture decreased by 0.061 times. Conclusion: In lateral DAA-THA, osteoporosis and ASIS-GTD are independent risk factors for femoral fractures. ASIS-GTD more than 90mm can be used as a preliminary screening criterion.