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The management of severe slipped capital femoral epiphysis (SCFE) is still controversial, because of a lack of long-term follow-up studies. Thirty-five patients (39 hips) with severe slipped capital femoral epiphysis, treated by corrective intertrochanteric Imhäuser osteotomy, were clinically and radiographically reexamined. The average age at the operation was 13.7 years (range, 8–17 years) and the reexamination was at an average of 23.4 years (range, 19–27 years) after the operation. At reexamination, 77% of patients were rated good to excellent clinically and 67% had good or excellent radiological results by the Southwick classification. Three patients had severe degenerative arthritic changes, and two patients developed avascular necrosis. We conclude that the Imhäuser osteotomy should be performed in severe deformities (>40° gliding angle) associated with poor function. Because other studies show good long-term results after in situ pinning only, the indication for Imhäuser osteotomy should be made carefully depending on clinical and radiological findings.