Background: Numerous series have documented short-term successes with cementless total hip arthroplasty (THA) and subtrochanteric shortening osteotomy for Crowe IV developmental dysplasia of the hip (DDH). However, data are lacking regarding long-term implant fixation and patient function. In this study, we aimed to evaluate the 10-year results of cementless THA with simultaneous subtrochanteric shortening osteotomy for Crowe IV DDH. Methods: We retrospectively reviewed 28 consecutive primaries cementless THAs performed in 24 patients with Crowe IV DDH between 1992 and 2005. Evaluation was performed through Harris Hip Scores, physical examination, and radiographic analysis. Results: At mean follow-up 10 years, 5 hips were revised, and 3 patients had died leaving 20 hips for clinical analysis. Harris Hip Score was significantly improved compared to preoperative values (43 vs 87 P < .0001). The 10-year survivorship free from revision for aseptic loosening was 89%. Twenty-nine percent patients had an early complication, but these did not have long-term deleterious effects on the reconstruction, and there were no reoperations for any reason after 7 years. Conclusions: In the longest series to date, cementless THA combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to dysplasia was associated with high rates of successful implant fixation and stable clinical improvement. (C) 2016 Elsevier Inc. All rights reserved.