Background: Hip dysplasia belongs to the most frequent hip deformities and is a relevant risk factor for osteoarthritis. Objectives: What is the influence of dysplasia on hip osteoarthritis? What is the indication for conservative treatment and surgical intervention? Material and Methods: A literature analysis up to 2021 providing data about the natural course of hip dysplasia and osteoarthritis was performed. In addition, publications were screened for the presence of criteria regarding patient selection as well as optimal timing of surgical interventions. Results: Most publications show an association between hip dysplasia and osteoarthritis. Decreasing acetabular coverage and instability (i.e. subluxation) increase the risk for the development of hip osteoarthritis. Surgical correction of hip dysplasia should be considered mainly for patients without relevant osteoarthritis. Concommittant other hip deformities should be corrected as well. Conclusion: In adolescent and adult patients with symptomatic hip dysplasia and limited degenerative changes pelvic osteotomies should be considered as primary treatment option. Conservative treatment is restricted to asymptomatic patients, patients with relevant degenerative changes who are not suitable for joint preserving surgery and an age above 50 years. If performed in young patients with hip pain, it should be considered only for a limited time, not risking the right moment for the operation and it’s protective influence.