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This study retrospectively evaluated the benefits and prognostic factors of slotted acetabular augmentation (SAA) used for treating painful residual or neglected dysplastic hips in adolescents and young adults. Methods: Sixteen hips in 15 patients underwent SAA at an average age of 14.4 years. The radiologic and functional outcomes were reviewed after an average follow-up of 6.6 years. Results: All the patients obtained marked alleviation of pain (p < 0.05). Harris hip score (HHS) was improved from 74.7 to 92.7 on average (p < 0.05). Postoperative center-edge angle, Sharp's angle, c/b ratio and femoral head coverage showed significant improvement (p < 0.01). Among the radiographic parameters, only the postoperative measurement of the femoral head coverage was significantly correlated with improvement of HHS (p < 0.05). Detectable progression of osteoarthritis, from grade III to IV, was found in one patient 12 years after surgery. None of the hips required conversion to joint replacement. There were no surgical complications. Three-dimensional computed tomography showed that the grafts remained intact and provided congruent coverage at the latest follow-up, and none of them required arthroplasty. Conclusion: The major benefit of SAA was to alleviate hip pain by increasing load-bearing area. This benefit was not sensitive to preoperative radiographic parameters. There were no postoperative complications. Compared with other complex reconstructive acetabuloplasty procedures, SAA is a simple, safe and effective pain-reducing procedure for symptomatic dysplastic hips in adolescents and young adults.