Background: Hip dysplasia is a major cause of secondary osteoarthritis, particularly in young adults. Total hip replacement (THR) is often required to restore function and improve quality of life. This main aim of this study was to evaluate the functional outcome, improvement in pain and health-related quality of life after THR in patients with dysplastic hips in Nepal. 
Methods: We retrospectively reviewed 31 cases who underwent THR for dysplastic hips from January 2021 to December 2024 at a tertiary level hospital in Nepal. Functional outcome was assessed using the Harris Hip Score (HHS), pain with Visual Analogue Scale (VAS), and quality of life with 36-Item Short Form Health Survey (SF-36) questionnaire. 
Results: The mean age of patients included in the study was 53.52 ± 4.63 years; 16 (51.61%) were female. The HHS significantly improved from 45.26 ± 2.61 pre-operatively to 89.16 ± 1.97 at one year. VAS score decreased from 7.39 ± 1.09 pre-operatively to 1.13 ± 0.56 at one year. The SF-36 score showed statistically significant improvements across all domains from baseline through one year post-operatively. Complications included sciatic nerve palsy (6.45%), hip dislocation (3.22%), and superficial infection (3.22%). 
Conclusion: This study found significant improvement in hip function, pain and health-related quality of life following THR in patients with dysplastic hips. 
Keywords: Dysplastic hip, Functional outcome, Harris hip score, Hip dysplasia, Quality of life, Total Hip Replacement.