Thirty-three patients (39 hips) with avascular necrosis of the femoral head (ANFH), who received vascularized iliac pedicle bone grafting at the Orthopaedic Department of Linkou Medical Center, Chang-Gung Memorial Hospital, were followed for more than 4 years (Group 1). Twenty-two patients with ANFH, who received free vascularized fibula bone grafting (Group 2) were followed for more than 3 years. Six parameters were adopted to evaluate the outcomes in both groups. Study results for the parameters of postoperative functional score, patient-evaluated outcome, radiographic progression, and conversion to replacement arthroplasty were not significantly different. However, the mean operation time for Group 2 was significantly longer than that for Group 1 (7 hr vs. 3.5 hr) and the mean complication rate for Group 1 was higher than that for Group 2 (8/39 vs. 1/22). Since both are palliative procedures with almost equal success rates, the easier procedure was chosen and complications carefully avoided.