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Thirty-one total hip arthroplasties, 20 primary and 11 revision, combined with femoral osteotomy in 28 patients for a major proximal femoral deformity were reviewed an average of 4.6 years after surgery. The type of femoral osteotomy used was a uniplanar wedge in 19 cases, biplanar in 4, and step cut in 8. The Harris hip rating score improved from an average of 51 to 77 points in primary cases and from an average of 35 to 73 points in revision cases. The average time until union of the osteotomy was 35 weeks. Complications included intraoperative femoral fracture in 7 cases, osteotomy nonunion in 4, instability in 4, aseptic femoral loosening in 4, osteolysis in 1, and deep infection in 1. Ten reoperations (32%) were performed in 8 patients. Total hip arthroplasty with concurrent femoral osteotomy is a technically demanding procedure. Stable initial fixation of the osteotomy is recommended to avoid osteotomy nonunion and failure.