This study evaluated total hip arthroplasty in patients with developmental hip dysplasia requiring femoral subtrochanteric shortening derotational osteotomy (SDO). Twenty-three total hip arthroplasties that required SDO were evaluated at an average follow-up of 8 years (range, 5-14 years). Clinical and radiographic data were retrospectively reviewed. Four hips (17%) failed requiring revision. Time to revision averaged 4 years (range, 1-8 years) with polyethylene wear and osteolysis etiologic in 3 of 4 failures. Survivorship was 75% at 14 years. Subtrochanteric SDO provided reliable correction of dysplastic femoral deformity, facilitated hip reduction at the anatomic center, and demonstrated predictable union in all cases. Wear-induced osteolysis was the major reason for revision, probably due to the relatively thin polyethylene liners required for the small acetabular components used in young, active patients.