Total hip surface replacement keeps the hip joint close to normal structure, preserves bone volume, restores the normal biomechanical properties of the proximal femur, and reduces the occurrence of stress masking; the joint is stable and has a wide range of motion; it is preferred in advanced developmental dysplasia of the hip (DDH) that is young and has high motor requirements. In DDH, the acetabular fossa is superficial and vertical, often with an anterolateral acetabular bone defect, which does not allow for adequate bony coverage of the acetabular prosthesis when reconstructing the acetabulum and affects the stability of the acetabular prosthesis. The developmental deformities such as increased anterior femoral neck angle on the femoral side, or flat femoral head, short and thick neck, as well as the difference in length of both lower limbs. Therefore, total hip surface replacement for DDH is very specific and challenging.