Objective To compare the clinical effect of direct anterior approach(DAA)and posterior approach(PA)in one-stage bilateral total hip arthroplasty.Methods The clinical data of 61 patients underwent primary total hip arthroplasty in Fuzhou Second Hospital,Affiliated Hospital of Xiamen University from January 2015 to December 2019 were retrospectively analyzed.Among the patients,32 cases were in DAA group and 29 cases were in PA group.The anesthesia time,intraoperative blood loss,postoperative hospital stay,the mean absolute error of cup anteversion and abduction angle,lower limb length discrepancy,Harris hip joint function scale(HHS)and postoperative complications were compared between the two groups.Results The anesthesia time and postoperative hospital stay in DAA group were shorter than those in PA group,the differences were statistically significant(P＜0.05).The HHS scores of the two groups at 1,3 and 6 months after surgery were higher than those before surgery,and the differences were statistically significant(P＜0.05).The HHS scores of DAA group at 1 and 3 months after surgery were higher than those of PA group,and the differences were statistically significant(P＜0.05).There was no significant difference in HHS score between the two groups at 6 months after surgery(P＞0.05).There was no significant difference in intraoperative blood loss between the two groups(P＞0.05).In postoperative imaging evaluation,acetabular inclination error,acetabular abduction angle error and absolute length difference of lower limbs in DAA group were all smaller than those in PA group,with statistical significances(P＜0.05).In DAA group,there were 4 cases of unilateral femoral lateral cutaneous nerve symptoms and 2 cases of unilateral femoral prosthesis.In the PA group,there was 1 case of unilateral femoral prosthesis.Conclusion The clinical application effect of direct anterior approach in one-stage bilateral total hip arthroplasty is better than that of posterior approach in total hip arthroplasty,which is worthy of clinical application.