Osteonecrosis of the femoral head eventually leads to the destruction of the femoral head, if it remains untreated. Depending on the localization and the extent of the osteonecrosis several surgical treatment options can be considered. For early small and medium-sized pre-collapse lesions, core decompression is the treatment of choice. Osteotomies and bone grafting procedures can be utilized in medium pre-collapse, as well as in small post-collapse lesions. Cartilage lesions of the femoral head allow limited femoral resurfacing arthroplasty. If the acetabulum reveals cartilage lesions, a total hip replacement should be preformed.