Severe femoral anteversion may require operative correction if it results in cosmetic or functional disability. Complication rates ≤l5% have been reported after derotational osteotomy. We report the results of 51 osteotomies in 27 patients with idiopathic femoral anteversion over a 15-year period at a major pediatric orthopaedic referral center. Thirty-four derotational osteotomies in 17 patients were performed using a supracondylar technique with crossed-pin fixation. There was a 14.7% complication rate. Sixteen osteotomies in 10 patients were performed using an intertrochanteric osteotomy and blade-plate fixation with the patient in the prone position; there were no reported complications. The intertrochanteric osteotomy allowed more accurate correction of the intoeing deformity and decreased the need for postoperative immobilization. In addition, the more secure blade-plate fixation benefits the active child >8 years of age who requires operative correction of severe femoral anteversion.