[Objective] To compare the clinical outcomes of direct anterior approach (DAA) versus conventional Watson- Jones ap- proach for lightbulb procedures, involving femoral neck-head fenestration, debridement and bone autografting, for treatment of early-stage non-traumatic femoral head necrosis. [Methods] A retrospective study was done on total of 116 patients who received lightbulb procedures for early-stage nontraumatic femoral head necrosis from June 2014 to June 2018. Among them, 40 patients (54 hips) had the operation per- formed through DAA approach, while the other 49 patients (62 hips) had lightbulb procedure conducted through the conventional WatsonJones approach. The perioperative, follow-up and radiographic documents were compared between the two groups. [Results] All patients in both groups were successfully operated on without serious complications. Although there were no significant differences in the operative time and intraoperative radiation exposure time between the two groups (P＞0.05) , the DAA group had significantly less intraoperative blood loss than that in the conventional group (P＜0.05) . The follow- up lasted for 24 to 45 months, with an average of (32.09± 14.08) months. There were no significant differences in the time to return walking and time to full weight-bearing activity between the two groups (P＞0.05) . The VAS scores decreased significantly (P＜0.05) , whereas the hip internal-external rotation range of motion (ROM) and Harris score significantly increased in both groups over time (P＜0.05) . At 6 months after operation, the DAA group was significantly superior to the conventional group in terms of VAS score and Harris score (P＜0.05) . By the time of the latest follow-up, successful rate of hip preserva- tion was 81.48% in the DAA group, whereas 72.58% in the conventional group. Radiographically, there were no statistically significant dif- ferences in terms of joint space, femoral head collapse or lesion area between the two groups at 6 months after surgery or at the latest followup (P＞0.05) . [Conclusion] Compared with the conventional Watson-Jones approach, DAA approach takes benefits of less trauma and bet- ter early functional recovery for treatment of early-stage femoral head necrosis.