We use varus-extension osteotomy (VEO) to treat patients with Legg-Calvé-Perthes' disease (LCPD) aged ≥5 years who have >50% of femoral head involvement. Based on our study and results from the literature, we argue that this operation should be undertaken before femoral head deformity occurs and as soon as possible after diagnosis. We suggest that it is more appropriate to contain the head by varus and extension rather than derotation.