ObjectiveTo systematically review the efficacy of total hip arthroplasty by direct anterior approach (DAA) and direct lateral approach (DLA). MethodsCNKI, WanFang Data, VIP, CBM, EMbase, PubMed, The Cochrane Library, ClinicalTrials.gov and PROSPERO databases or websites were electronically searched to collect randomized controlled trials (RCTs) of DAA and DLA for THA from inception to August 6th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 9 RCTs were included. The results of meta-analysis showed that at 3 months post-operation, the Harris hip score (HHS) of the DAA group was higher than the DLA group (MD=4.83, 95%CI 2.09 to 7.56, P=0.000 5). Besides, compared with the DLA group, the DAA group showed shorter incision length (MD=−2.35, 95%CI −3.90 to −0.79, P=0.003), less intraoperative bleeding (MD=−68.24, 95%CI −119.07 to −17.41, P=0.009), and shorter hospital stay (MD=−0.84, 95%CI −1.54 to −0.15, P=0.02). However, no significant differences were found between DLA and DAA in operation duration and HHS at 6 weeks after operation. ConclusionsCurrent evidence shows that DAA can provide better HHS at 3 months post-operation, shorter incision length, less intraoperative bleeding, and shorter hospitalization length than DLA. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.