Usually the treatment of severe gluteal muscle contracture in children does not achieve a satisfactory clinical result and the disease is prone to recurrence after surgery. The aim of this study was to analyze the factors influencing the recovery of children with severe gluteal muscle contracture. Between 1997 and 2008, 428 children (mean age: 8 years) were subjected to surgical operations combined with functional exercises and physical therapy and were followed for 12-24 months with satisfactory clinical outcomes. In this series, the outcomes were found to be excellent in 400 cases, good in 22 cases, and fair in six cases with no patient having a poor result. No serious complications, such as sciatic nerve injury, dislocation, or osteonecrosis of the femoral head were found in the patients. Unsteadiness in walking and positive Trendelenburg sign were found in postoperative functional exercises in 16 patients, which may be the result of excessive resection of the gluteus medius and the gluteus minimus. However, the symptoms in all the cases disappeared within 3 months by rigorous functional exercise. We evaluated the factors that potentially influence the clinical outcome retrospectively and it was concluded that the surgery was highly beneficial for the treatment of the patients. Postoperative functional exercise and physical therapy could reduce the complications and maintain the favorable effects of surgery. In addition, the identification of the disease, the age of patients, and the rehabilitation procedures after hospital discharge were found to be very important for the successful treatment of this condition.