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Core decompression is a joint-preserving operative technique that aims to improve blood flow to the femoral head by decreasing intraosseous pressure, thereby potentially delaying or preventing THA. Traditional core decompression is performed using a trephine to remove an 8-mm to 10-mm core from the osteonecrotic lesion in the femoral head, while avoiding penetrating the articular surface. Bone grafting has been used to treat ONFH since the mid-twentieth century and is theorized to prevent femoral head collapse by providing structural support. Non vascularized cortical autograft or allograft has been inserted into the osteonecrotic femoral head lesions using the Phemister technique (using the core decompression tract accessed through the lateral proximal femur), the lightbulb technique (via a cortical window in the femoral neck accessed through an anterior arthrotomy), and the trapdoor technique (via a flap of articular cartilage accessed through surgical dislocation). These procedures are generally indicated for small to medium-sized lesions in younger patients seeking to delay or prevent THA, with lower-level supporting evidence. Vascularized bone grafting is thought to combine the structural support of non vascularized bone graft with increased healing potential from a revived blood supply.Vascularized bone graft can be harvested from a patient’s fibula, iliac crest, and greater trochanter For patients with advanced ONFH or failure of joint-preserving operative treatments, total hip arthroplasty is the best option with excellent outcomes in terms of pain relief and survivorship.