[Objective] To explore the causes of the complications and prevention methods in femoral neck fractures treated with total hip arthroplasty (THA) through the direct anterior approach (DAA) under traction. [Methods] A retrospective analysis was performed on 358 elderly patients with femoral neck fracture who underwent DAA-THA with the use of a traction table from January 2018 to June 2021. Intraoperative and postoperative complications within 90 days were regarded as early complications, and those whose symptoms were still presented after 90 days were defined as late complications. The incidence and treatment of various complications were statistically analyzed. The causes of complication were also summarized and recorded. [Results] Sixty-three cases (17.6%) had complications in 358 patients. Among them, 34 were early complications, whereas the remaining 29 were late complications. No significant difference was found between incidence of early complications and late complications(P＞0.05). Of the 34 early complications, the incidence of limb length discrepancy was 3.4%, 2.8% in incisional drainage, 1.7% in ankle pain, and 1.7% in periprosthetic fracture. The incidence of early complications caused by surgical techniques were significantly higher than that due to patient's factors(P＜0.001). Late complication was lateral femoral cutaneous nerve (LFCN) injury, with incidence of 8.1%. [Conclusion] There are many complications such as LFCN injury, limb length discrepancy, incisional drainage, ankle pain, and periprosthetic fracture during the treatment of femoral neck fractures with DAA-THA by assistance of traction. Full awareness of patient's condition, improving surgical skills, and paying attention to postoperative rehabilitation can reduce the incidence of complications.