Legg-Calve-Perthes disease is a multifactorial process that can lead to debilitating femoral head deformity in children. Management can range from conservative (such as nonweightbearing protocols), bracing (such as A frames), to more invasive measures involving surgical interventions. First described by Axer in 1965, the varus derotational osteotomy (VDRO) has been a staple in the surgical management of Perthes disease. The goal of the VDRO is "containment" or prevention of extrusion of the head from the acetabulum. Many variations of the technique have been described over the years since its inception, but the most important factor in outcome is timing the intervention at the appropriate stage of Perthes disease to allow for maximum benefit. Through varusization of the neck shaft angle of the proximal femur, the VDRO has been shown to be a powerful tool in the management of those afflicted. As with any operative procedure, the VDRO can be associated with complications such as premature epiphyseal closure leading to shortened extremity, albeit very rare in occurrence. The VDRO is a mainstay in the treatment algorithm for Legg-Calve-Perthes disease and will continue to remain so in the future.