Objective To analyze and summarize the clinical effectiveness of total hip arthroplasty（THA） with structural femoral head autografting for acetabular reconstruction in the treatment of adult patients with revised Crowe type ⅣB developmental dysplasia of the hip（DDH）. Methods We included 26 patients（25 males and 1 female） who were diagnosed with type ⅣB DDH according to the revised Crowe classification and underwent THA with structural femoral head autografting for acetabular reconstruction in the Department of Joint Surgery，Qilu hospital of Shandong University Dezhou hospital from August 2015 to March 2023. The surgical time，intraoperative blood loss，intraoperative blood transfusion volume，postoperative blood transfusion volume，postoperative hemoglobin content，surgical complications，and bone healing time were recorded. Anteroposterior pelvic X-rays were taken to examine prosthetic position，bone ingrowth，prosthetic loosening，and bone healing. The visual analogue scale（VAS） score was used to assess the intensity of pain in the hip. The Harris hip score and the Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC） were used to evaluate hip function and clinical effectiveness. Results For all the cases，the mean follow-up time was （9.73±8.35） months，the mean intraoperative blood loss was （715.38±143.37） mL，the mean intraoperative blood transfusion volume was （415.38±282.41） mL，the mean surgical time was （118.62±18.27） min，and the mean postoperative blood transfusion volume was （192.31±236.51） mL. All the patients had good healing between the subtrochanteric region，femoral head autograft，and false acetabulum. The hip VAS score showed a significant decline from （6.73±0.45） points before operation to （1.73±0.53） points at the last follow-up after operation（P<0.001）. The ranges of motion of the hip joint were all significantly improved. The Harris hip score was increased significantly from （24.27±1.66） points before surgery to （74.77±2.89） points at the last follow-up after surgery（P<0.001）. The WOMAC score showed a significant decrease from （130.08±5.72） points before surgery to （67.85±3.23） points after surgery（P<0.001）. Conclusion THA with structural femoral head autografting for acetabular reconstruction is a relatively simple procedure to perform，with good fixation，safety，and effectiveness for the treatment of revised Crowe type ⅣB DDH.