Many conditions produce femoral deformities that complicate primary total hip arthroplasty (THA). In each patient, treatment must be individualized to address the level of the deformity, the type of deformity, and bone quality, as well as surgeon preference. The S-ROM femoral component (DePuy Orthopaedics, Warsaw, Ind) is useful for many deformities from the level of the greater trochanter to the diaphysis. The S-ROM stem optimizes proximal and distal implant stability, allows maximal torsional stability during osteotomies, and permits easy adjustments to anteversion, offset, and leg length to provide optimal biomechanical reconstruction of the deformed femur in THA. Clinical results with few complications are achievable when using the S-ROM stem in complex deformities.