Abstract: [Objective] To analyze the safety and efficacy of direct anterior approach with Bikini incision in lateral decubitus position in patients undergoing total hip arthroplasty. [Methods] Retrospective analysis was performed on 78 patients with congenital hip dysplasia, femoral head necrosis and femoral neck fracture who received total hip arthroplasty in our hospital. Group B received direct anterior approach total hip arthroplasty with Bikini incision in lateral decubitus (40 cases). Patients in the traditional group received total hip arthroplasty with traditional longitudinal incision approach (38 cases). Outcome measures included perioperative period, follow-up period and imaging evaluation. [Results] The perioperative indexes of group B were significantly lower than those of the traditional group (P<0.05). During follow-up, the incidence of adverse events in group B was significantly lower than that in the traditional group (P<0.05). The hip pain and functional scores in group B were significantly better than those in the traditional group (P<0.05). There was no significant difference in the radiographic parameters such as acetabular abduction Angle and anterior inclination Angle between group B and traditional group (P>0.05). [Conclusion] In the patients receiving total hip arthroplasty, the application of Bikini incision in lateral decubitus position to the surgical treatment of direct anterior approach is satisfactory in terms of restoring hip function, relieving pain symptoms and promoting scar healing. It can also effectively avoid the occurrence of postoperative adverse reactions.