Background: The evolution of total hip arthroplasty (THA) generally has led to improved clinical results. However, THA in very young patients historically has been associated with lower survivorship, and it is unclear whether this, or results pertaining to pain and function, has improved with contemporary THA. Questions/purposes: We performed a systematic review of the English literature on THA in patients 30 years of age and younger to assess changes in (1) indications; (2) implant selection; (3) clinical and radiographic outcomes; and (4) survivorship when comparing contemporary and historical reports. Methods: Multiple databases were searched for articles published between 1965 and 2011 that reported clinical and radiographic outcomes of THA in patients 30 years and younger. Sixteen retrospective case series were identified. Surgical indications, implant selection, clinical and radiographic outcomes, and survivorship of patients undergoing THAs before 1988 were compared with those performed in 1988 and after. Results: Reported THAs performed more recently were less likely to be performed for juvenile rheumatoid arthritis than earlier procedures. Cementless fixation became more prevalent in later years. Although clinical outcome scores remained constant, aseptic loosening and revision rates decreased substantially with more contemporary procedures. Conclusions: This review of the literature demonstrates an improvement in radiographic outcomes and survivorship of THA, but no significant differences in pain and function scores, in very young patients treated over the past two decades when compared with historical controls.