Introduction: Avascular necrosis (AVN) is a devastating complication of slipped capital femoral epiphysis (SCFE) and is difficult to treat. The incidence of AVN in this condition varies considerably and is reported to appear in 3–47% of patients. The aims of the treatment of AVN are to maintain range of movement of the hip whilst preventing collapse of the femoral head. Clear treatment guidelines of this condition do not currently exist and the treatment of this condition can be difficult and unrewarding.

Method: Dynamic arthrograms were used to assess of cases of AVN in order to determine the method of treatment. We present 20 sequential cases of AVN in patients presenting to our unit with SCFE and report the long-term results of treatment with a mean follow-up in excess of 10 years.

Results: In 100 consecutive cases of SUFE there were 20 cases of AVN. There were 18 cases of salvage surgery and one patient refused surgery. Of the 18, there were 2 acetabuloplasty procedures, 12 proximal valgus osteotomies and 4 arthrodeses. At a later date there were 3 proximal femoral osteotomies and 5 total hip replacements.

Discussion: There is a good functional result in the majority of cases and a logical approach delays the need of total hip replacement in the majority of cases. The management depends on the radiography, the arthogram and the EUA. If there is early AVN with no collapse the treatment is a shelf procedure. If there is hinge abduction the treatment is a valgus femoral osteotomy. If there is instable movement and the hip is not congruent the treatment is hip arthrodesis.