We employed hypotensive anesthesia with prostaglandin E1 (PGE1) and transfused 400 ml of autologous whole blood on the first postoperative day to avoid homologous blood transfusion in 137 patients undergoing rotational acetabular osteotomy (RAO) and RAO combined with intertrochanteric valgus osteotomy. Four hundred ml of whole blood were donated 1 week before the surgery, and transfused on the first postoperative day after hematological examination. We employed induced hypotension with PGE1 under general anesthesia with enflurane or isoflurane. Intraoperative systolic blood pressure was maintained at approximately 70-80 mmHg. The mean operation time was 139 +/- 32 minutes. The mean intraoperative and the postoperative estimated blood loss was 286 +/- 152 g and 259 +/- 122 g, respectively. The mean hemoglobin content was 13.3 +/- 1.1 g/dl before the operation. It showed the lowest value of 9.4 +/- 1.0 g/dl on the first postoperative day but it returned to 10.4 +/- 1.0 g/dl in the second postoperative week. There was no use of homologous blood transfusion. We consider that the concomitant use of autologous blood donation and hypotensive anesthesia is an extremely useful method to avoid homologous blood transfusion.