Acetabular dysplasia is a common cause of hip pain and can lead to premature osteoarthritis. Preserving the native hip is the first choice in young, active patients with minimal arthrosis. Techniques in rotational pelvic osteotomy have evolved to offer long-term benefits, but appropriate patient selection is an important determinant of success. Applying a stepwise approach when evaluating adult patients with acetabular dysplasia and understanding current outcomes and predictive data will allow the orthopaedic surgeon to choose appropriate candidates for pelvic osteotomy.