[Objective] To compare the clinical outcomes of direct anterior approach (DAA) versus posterolateral approach (PLA) for to- tal hip arthroplasty (THA) in the treatment of osteoporotic femoral neck fractures. [Methods] From January 2019 to December 2021, a total of 68 patients received THA for osteoporotic femoral neck fractures in our hospital. According to doctor-patient communication, 33 patients had THA performed through DAA, while the other 35 patients were through PLA. The clinical data of the two groups were compared. [Re- sults] All patients in both groups had THA performed successfully without intraoperative death or other serious intraoperative complica- tions. Although the DDA group consumed significantly longer operation time than the PLA group [(106.8±14.0)min vs (91.2±12.0)min, P＜ 0.001], the DAA group proved significantly superior to the PLA group in terms of incision length [(11.9±1.8)cm vs (14.8±2.2)cm, P＜0.001], intraoperative blood loss [(172.2±25.9)ml vs (212.0±33.7)ml, P＜0.001], postoperative walking time [(26.2±8.3)hours vs (44.4±11.8)hours, P＜ 0.001] and hospital stay [(6.8±0.6)days vs (9.8±1.3)days, P＜0.001]. In addition the DAA group was marked significantly lower VAS scors for pain [(4.1±0.7) vs (5.5±1.0), P＜0.001], whereas significantly higher Harris score [(73.9±6.5) vs (64.8±5.9), P＜0.001] than the PLA group 3 days postoperatively. All patients were followed up for more than 6 months, the VAS scores decreased significantly (P＜0.05), while Harris score increased significantly over time in both groups (P＜0.05), which proved not significantly different between the two groups at 3 and 6 months after surgery (P＞0.05). [Conclusion] The DAA for THA in the treatment of osteoporotic femoral neck fractures takes the advantages of less injury and faster early postoperative recovery over the PLA.