Objective To study the clinical efficacy of Bikini incision minimally invasive total hip arthroplasty on elder patients with femoral head necrosis and its effect on bleeding.Methods Seventy-six elder patients with femoral head necrosis in Sanmenxia Central Hospital from January 2015 to December 2016 were randomly divided into the study group(38 cases)and the control group(38 cases).The patients in the study group were treated with Bikini incision minimally invasive total hip arthroplasty by anterior approach,while the control group underwent total hip arthroplasty by anterolateral approach.Harris score and WOMAC score were used to evaluate the clinical function of hip joint.The operation time,length of incision,intraoperative blood loss, blood transfusion,hospitalization time,hemoglobin level at 72 h after surgery,the first ambulation time,the lower limb length discrepancy,postoperative complication were recorded and compared between two groups.Results The Harris scores at 1,2,4 months after operation in the two groups were significantly improved(P<0.05), while WOMAC scores of patients at 1,2,4 months after operation were significantly lower than those before treatment(P<0.05).However,there were no significant differences at different time between the groups(P>0.05).The hospitalization time and the first ambulation time in the study group were significantly shorter than those in the control group((6.1±2.8)d vs.(7.9±3.2)d,P=0.011;(5.3±1.5)d vs.(6.4±1.7)d,P=0.004).After 4 months of treatment,the lower limb length discrepancy in the study group was less than that of the control group((6.5 ± 2.3)mm vs.(10.4 ± 3.5)mm,P<0.01).In addition,there were no significant differences between two groups in the operation time,length of incision,complication occurrence,intraoperative blood loss and blood transfusion(P>0.05).Conclusion Treating femoral head necrosis with Bikini incision minimally invasive total hip arthroplasty can achieve favorable effectiveness,with no increase in intraoperative blood loss and rapid recovery of postoperative joint function,but further follow-up is needed.