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Background To explore the technique and the clinical results of total hip arthroplasty ( THA ) with transverse subtrochanteric osteotomy and monocortical locking plate for Crowe type Ⅳ developmental dysplasia of the hip ( DDH ). Methods From April 2015 to April 2019, 21 patients ( 23 hips ) with Crowe Ⅳ DDH were treated by the technique of THA with transverse subtrochanteric osteotomy and monocortical locking plate. Postoperative clinical and radiological results were evaluated. Results All of the patients were followed up for the average of 33 months. All patients had no osteotomy nonunion, infection, prosthesis loosening and vascular nerve injury. 1 patient experienced dislocation one week after the operation because of bad posture. Harris score changed from 35.6 points ( 25–51 ) before surgery to 88.1 points ( 76–96 ) after surgery. Conclusions THA with transverse subtrochanteric osteotomy and monocortical locking plate internal fixation for the patients with Crowe type Ⅳ DDH is an effective way.

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