Background: Osteonecrosis continues to be a challenging disease to treat and it often affects young patients who want to maintain an active lifestyle. Objective: The aim of the present study was to evaluate the clinical and radiological outcomes of core decompression for Ficat stage I,II or III femoral head avascular necrosis. Patients and methods: This interventional clinical trial included 30 hips in 18 patients with avascular necrosis (AVN) of femoral head Ficat type I,II or III, conducted at Orthopaedic department, Zagazig University Hospitals. Pre- and post-operative clinical evaluation and radiological assessment were applied. Results: There was a highly statistically significant increase in the Harris Hip scores from.There was a highly statistically significant decrease in the Modified Kerboul angle.There was a statistically significant negative correlation between the improvement in Harris Hip scores and each of BMI, Ficat stage, and post-operative Modified Kerboul angle as an increase in each of them was associated with decreased percent of improvement. Conclusion: Core decompression when performed before femoral head collapse has been advocated as an efficient technique to stop or delay the progression of the disease in young individuals.