Background <p>This study aimed to compare the long-term effects of Salter and Pemberton osteotomies on spinopelvic alignment and the development of scoliosis in patients with developmental dysplasia of the hip (DDH).</p> Methods <p>This retrospective study included 127 patients who underwent unilateral Salter or Pemberton osteotomy between 2004 and 2012 at 1–3 years of age. Fifty-five patients treated non-surgically using a Pavlik harness or casting served as the control group. Patients were grouped into unilateral Pemberton osteotomy (Group 1), unilateral Salter osteotomy (Group 2), and controls (Group 3). Long-term radiographic outcomes were assessed using Cobb angle (CA), lumbar lordosis (LL), iliac tilt (IT), sacral tilt (ST), pelvic obliquity (PO), sacral slope (SS), and leg length discrepancy (LLD). Propensity Score Matching (PSM) technique was used to balance the demographic differences between groups, including age, sex, and follow-up duration.</p> Results <p>The incidence of scoliosis was significantly higher in the Salter group compared to the Pemberton and control groups (<i>p</i> &lt; 0.05). Significant deviations in iliac tilt and sacral tilt were also noted in the Salter group (<i>p</i> &lt; 0.01). Spinopelvic parameters in the Pemberton group were more comparable to those of the non-operated control group. Logistic regression analysis revealed that increased sacral tilt, iliac tilt, and pelvic obliquity were independent risk factors for scoliosis (<i>p</i> &lt; 0.01, <i>p</i> &lt; 0.05, and <i>p</i> &lt; 0.05, respectively).</p> Conclusions <p>Salter osteotomy may increase the risk of long-term spinopelvic misalignment and scoliosis in patients with DDH. In contrast, Pemberton osteotomy appears to better preserve spinopelvic alignment. These findings suggest that long-term axial alignment should be considered during surgical planning in DDH management.</p>