In total hip arthroplasty for developmental high dislocations, placement of the implant cup in the true acetabulum and femoral-shortening osteotomy can produce satisfactory results. We performed total hip arthroplasties in 25 high dislocated hips (22 patients) between 1992 and 2000, placing all cups in the true acetabula and using noncemented components and performing a femoral-shortening osteotomy in 22 hips. The overall complication rate was 36%. At follow-Lip evaluation at an average of 5 years later, patients' mean scores had improved as follows: pain, from 2.3 to 5.7; function scores, from 2.3 to 4.5; mobility scores, from 2.3 to 4.4; Harris hip scores, from 37.8 to 95. We recommend both placing the cup in the true acetabulum to maximize host-bone contact with the implant and preserve as much host bone as possible and femoral-shortening osteotomy for a lower incidence of nerve injury than with aggressive soft-tissue release.