Alternatives to total hip arthroplasty should always be considered for patients younger than 45 years. The indications for pelvic osteotomy are painful acetabular dysplasia with subluxation of the hip and early secondary degenerative arthritis, in which the majority of the deformity is on the acetabular side of the joint. For more severe deformity combined pelvic and femoral osteotomies may be necessary. Depending on the extent of the acetabular deformity there are a number of pelvic osteotomies available. With careful patient selection, correct indications and precise operative technique, significant relief of symptoms and excellent function may be obtained in most patients for 8 to 10 years after the operation. Pelvic osteotomy thus postpones the need for total hip arthroplasty to a stage in life at which results are better, and it enhances the bone stock to support the acetabular component.