Objective To investigate the clinical outcomes of direct anterior approach (DAA) total hip replacement when using surgical fixation device and how it differs from the conventional DAA total hip replacement. Methods Patients who planned to undergo total hip replacement through DAA at The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 1 to Jun. 30, 2022 were selected. Patients who underwent total hip replacement through DAA from Jan. 1 to Mar. 31 were included in the observation group. Patients who underwent total hip replacement through DAA from Apr. 1 to Jun. 30 were included in the control group. The patients in the observation group were fixed with surgical fixation device, while the patients in the control group were fixed with conventional surgical methods. The operation time, the number of cases required by the first assistant to complete the learning curve of operation draping, the assistant number, the acetabular prosthesis anteversion angle, the incidence of complications, visual analog scale (VAS) and Harris scores before and 6 weeks after surgery were analyzed in the 2 groups. Results A total of 110 cases were included. Forty-eight patients were assigned to the observation group, while the others were assigned to the control group. No significant differences were found in the general information and preoperative indicators of the 2 groups (all P＞0.05). Compared with the control group, the time taken for preoperative sterilizing or draping in the observation group was shorter (［15.3±2.1］ min vs ［21.4±4.3］ min, P＜0.05). The numbers of cases required for the first assistant to complete the learning curve in the observation group and control group were 4.7±0.6 and 7.3±1.2, respectively. Fewer surgical assistants were required in the observation group than in the control group (2 vs 3). The acetabular prosthesis anteversion angle in the observation group was smaller than that in the control group, but with no significant difference (18.4°±3.4° vs 21.3°±2.2°,P＞0.05). There were significant differences in VAS scores and Harris scores of the 2 groups before and 6 weeks after surgery (all P＜0.05), while there were no significant differences in VAS scores or Harris scores between the 2 groups (all P＞0.05). Conclusion A surgical fixation device for DAA total hip replacement can shorten the preoperative sterilizing and draping time, reduce the duration in operating room, and requires less assistants and training time, making it easier to know the acetabular prosthesis position during the operation.