Thirty-eight patients (fifty-four hips) with developmental dysplasia of the hip were randomized to proximal iliopsoas tenotomy at the pelvic brim (n=27 hips) or distal tenotomy just above the lesser trochanter (n=27 hips); all procedures used an anterior approach. The primary outcome was hip-flexion strength (Medical Research Council scale). Secondary outcomes included intraoperative bleeding, femoral nerve injury, and avascular necrosis (AVN) of the femoral epiphysis. Outcomes were assessed at 6, 12, and 24 months. Overall, the results revealed higher median flexion strength at 24 months with proximal release (grade 5) versus distal and fewer total complications. These findings suggest proximal release facilitates earlier and better recovery of hip-flexion strength with a lower complication burden.