Untreated hip dysplasia predisposes young adults to early arthritis. Varus rotational osteotomies are considered one option to delay or eliminate total hip arthroplasty. We update a report from 1991 by retrospectively reviewing 40 of 48 patients (83.3%) who had 45 varus rotational osteotomies from 1971 to 1986 with a minimum followup of 15 years (mean, 22.6 years; range, 15-34 years). Results were assessed using Hospital for Special Surgery hip scores and radiographic parameters. The average age of the patients at followup was 57.2 years (range, 38-81 years). Fourteen patients (35%) (16 hips) had no additional procedures at 21.2 years followup (range, 15-27 years). The average Hospital for Special Surgery hip score was 33.7 with a Tönnis scale of 1.7 (mild-moderate osteoarthritis). Twenty-six patients (65%) (29 hips) had total hip arthroplasties an average of 9.75 years (range, 2-27 years) after varus rotational osteotomy. As in the initial study, the degree of preoperative osteoarthritis was a predictive value for success of the varus rotational osteotomy. Additionally, younger patients with minimal hip subluxation and osteoarthritis, and a better preoperative Hospital for Special Surgery hip score were predictors of success.