Objective To investigate the effectiveness of subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip (DDH). Methods Between January 2004 and December 2010, 37 patients (44 hips) with Crowe type IV DDH underwent subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty with cementless prosthesis. There were 15 males (18 hips) and 22 females (26 hips) with an average age of 42 years (range, 24-46 years). Unilateral hip was involved in 30 cases and bilateral hips in 7 cases. Preoperative X-ray films showed complete dislocation of the femoral head and hypoplasia of the acetabulum and proximal femur. Before operation, the leg discrepancy was (5.5 ± 1.1) cm, and the Harris score was 32.1 ± 5.2. Results The mean operation time was 4.3 hours (range, 3-6 hours); the mean blood loss was 760 mL (range, 600-1 000 mL). All patients obtained primary healing of incision. The patients were followed up 1-8 years (mean, 6.7 years). Pain relief was achieved; 6 cases had mild claudication; 3 cases had femoral nerve palsy; and no stretch injury of sciatic nerve was observed. X-ray films showed that acetabular cups were in normal position. The healing time of fracture was 3-6 months (mean, 3.7 months). The leg discrepancy was (1.5 ± 1.0) cm at 1 day after operation, showing significant difference when compared with preoperative one (t=16.45, P=0.00). The Harris score was 94.3 ± 3.8 at 3 months after operation, showing significant difference when compared with preoperative score (t=59.15, P=0.00). No revision of acetabular and femoral prostheses was performed during follow-up. Conclusion Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty is a safe method of restoring the anatomic hip center in Crowe type IV DDH in adults. It can avoid reduction difficulty caused by soft tissue contracture and injuries of sciatic nerve and femoral nerve caused by limb lengthening.