Long-Term Prosthesis Survival After Total Hip Arthroplasty in Young Women with Developmental Dysplasia of the Hip: A Narrative Review of Instability, Revision Risk, and Reproductive Health Considerations

Abstract

Background/Objectives: Total hip arthroplasty (THA) reliably improves pain and function, but implant longevity in women aged ≤50 years is influenced by longer duration of implant use and distinct failure mechanisms. Developmental dysplasia of the hip (DDH) is a common underlying diagnosis among patients undergoing THA at younger ages and may increase instability risk, while pregnancy after THA remains an important but understudied consideration. Methods: A narrative review of contemporary studies published from January 2000 through January 2026, supplemented by seminal older studies when directly relevant, was conducted. Evidence was synthesized by clinical mechanism and endpoint, with an emphasis on instability, revision, and pregnancy-related outcomes. Results: Outcomes were generally favorable in young women undergoing THA. DDH-related anatomic complexity may increase instability risk, but this risk appears highly modifiable through contemporary reconstructive and implant strategies. Pregnancy after THA was not consistently associated with increased dislocation or revision, though DDH-specific data are sparse. Conclusions: In women aged ≤50 years, THA longevity is shaped by both prevention of early instability-related revision and preservation of durable long-term fixation. DDH should be viewed as a reconstructive phenotype requiring stability-focused surgical planning and counseling. Future research should standardize instability reporting and evaluate the interactions among DDH severity, implant strategy, and long-term revision risk.