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The basic concepts and goals of pelvic support osteotomy (PSO) are to enhance femoro-pelvic stability by proximal femoral valgus osteotomy and to improve hip biomechanics by displacing the center of gravity medially, which results in an improvement in the mechanical efficiencies of abductor muscles. However, the clinical application of traditional PSO is limited due to its intrinsic shortcomings. Ilizarov designed a modified PSO, so called “Ilizarov hip reconstruction (IHR),” which incorporated a second distal femoral osteotomy, to realign the knee joint and to correct limb-length discrepancy and proximal femoral valgus osteotomy for pelvic support. IHR remains as a viable option for the salvage of severely damaged hips in the adolescents and young adults in whom arthrodesis or hip arthroplasty is not suitable. The purpose of this article is to briefly review the evolution of PSO and to concentrate on the technical considerations and outcomes of IHR.