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Total hip arthroplasty (THA) for the treatment of high congenital dislocation of the hip is a complex and technically demanding procedure. The difficulties encountered are due to the variety of anatomic deformities seen in these patients. Morphologic alterations are seen in the acetabulum, femur and the affected side of the pelvis, as well as the soft tissues. The main difficulty remains the restoration of the hip anatomy by recognizing the true position of the acetabulum, implantation of the acetabular cup and the safe reduction of the prosthesis. This is considered essential in order to restore normal hip kinematics and achieve patient satisfaction. Femoral shortening osteotomies have been introduced to facilitate reduction, while avoiding the various complications that are caused by excessive stretching of the soft tissues, such as nerve injuries. Different type of osteotomies have been described, that can be used in the proximal, subtrochanteric or distal femur; each having unique advantages and disadvantages. Familiarity is important in selecting and implementing the proper procedure. Furthermore, awareness of potential complications is imperative in avoiding pitfalls and improving outcomes and patient satisfaction. This article reviews the various types of femoral shortening osteotomies that have been reported in the literature and describes their features along with their technical difficulties and disadvantages. Also reports our experience using the majority of those osteotomies.

Shortening Osteotomies for Total Hip Replacement in High Congenital Dislocation of the Hip