Observation of patients with avascular necrosis of the femoral head formed a hypothesis about inability to eliminate the hip contracture by tunneling the femoral head on the background of drug therapy and therapeutic exercises, which causes an unsatisfactory outcomes. Therefore, the was idea to use arthroscopy for performing capsulotomy, synovectomy and removal of free cartilage and bone fragments. Objective. To evaluate efficiency of arthroscopy in patients with avascular necrosis of the femoral head. Methods. In the period from 2010 to 2018, 60 patients were observed. With the I–II stages, absence of inflammatory processes in the joint, body mass index less than 35. In the comparison group (28 patients) we made only tunneling of the femoral head, in the study group (32) at first we performed arthroscopy of the hip joint, capsulotomy, synovectomy, removal of cartilage fragments, and only then — tunneling. We analyzed the proportion of hip joint replacement that was performed in the long term follow up and the intensity of pain by visual analog scale. Results. During arthroscopy we often revealed the joint cartilage lesions — 30 %, articular labrum lesions — 5 %, synovitis — 100 %, CAM impingement — 90 %. In the study group in the first 2 weeks after surgery, the pain was severe more than in the comparison group. Then the pain rate became the same in both groups. In the control group in the period from 3 to 5 years after tunneling of the femoral head, arthroplasty was performed in 11 patients (39.3 %), in the study group for 2 to 3 years after surgery — 8 (25.0 %). Conclusions. Analysis of long-term results of tunneling of the femoral head with arthroscopy of the hip joint in patients with avascular necrosis of the femoral head showed improvement in hip function, no disease progression in 60–75 % patients in 2–3 years after surgery.