Bernese periacetabular osteotomy (PAO), an effective treatment for patients with developmental dysplasia of the hip (DDH), is characterized by wide exposure, cancellous bone surgery, and difficult techniques. In addition, the hip joint is deep and of rich muscles and neurovascular supply, which significantly increases bleeding. For patients who had combined proximal femoral osteotomy (PFO), the blood loss may be tremendous. The blood management for PAO is still challenging. We aimed to evaluate the effectiveness of multi-modal blood management for PAO and PAO combined with PFO. Patients and Methods: We retrospectively evaluated patients who had PAO with or without combined procedures from June 2010 to December 2018 in our department. The multi-modal blood management protocol included three parts: (i) pre-operationautologous component blood donation and iron supplement/erythropoietin; (ii) during operationcontrolled hypotension anesthesia, intraoperative auto-blood transfusion, tranexamic acid (20 mg/kg, IV / 0.5 g local), and standardized surgical procedure to shorten surgical time; and (iii) post-operationno drainage used, selective allo-blood transfusion, and ice packing technique. As the lacking of the above standard blood management protocol during PAO or PAO + PFO initially, we divided all the patients into three groups: Group A (PAO)before protocol started, 74 hips; Group B (PAO)after protocol finalized, 178 hips; Group C (PAO + PFO)after protocol finalized, 55 hips. The intraoperative blood loss, surgical time, allo-transfusion rate, pre-and postoperative hemoglobin were compared among groups. Results: Both the general characteristics and preoperative hemoglobin were comparable among the three groups