Osteonecrosis of the femoral head is a devastating disease with many patients ultimately requiring a total hip arthroplasty. When the disease is diagnosed in its early stages (before collapse of the femoral head), various procedures such as core decompression (with and without bone grafting), osteotomies, as well as nonvascularized and vascularized bone grafting can be used in an effort to preserve the joint. The efficacy of core decompression has been peer-reviewed in more than 40 studies. In general, this treatment is most successful for patients with early stage, small- and medium-sized lesions, before collapse of the femoral head. Various methods of nonvascularized bone grafting have been used. Results have varied; however, a 60% to 80% success rate has been achieved at 5- to 10-year follow-up. In the future, these procedures may be used with various other biologic adjunctive growth and differentiation factors, which may lead to higher rates of successful treatment.