Lateral x-ray of the femur in patient with unstable slipped capital femoral epiphysis (SCFE) at the time of acute injury on the left photo. Note that the femoral epiphysis is severely displaced posteriorly. The middle photo shows the six-month postoperative radiograph after screw fixation. Avascular necrosis (AVN) is not evident yet. Five years postoperatively, avascular necrosis is developing. He doesn't have much hip pain at this time so he is not an immediate candidate for total hip arthroplasty at this time. If arthritic deterioration of the hip may progress or chondrolysis occurs, we may have to consider reconstructive procedures such as total hip arthroplasty or hip fusion earlier in adulthood.