The cases of 80 patients with necrosis of the femoral head who underwent operative treatment in the period April 1980 to April 1988 are reported. Altogether, 102 operative procedures were carried out: 48 intertrochanteric osteotomies, 50 arthroplasties, 3 subchrondral bone graftings, and in one case drilling of the necrotic focus. Joint-preserving methods in advanced-stage disease seem to be of doubtful use when judged by clinical and socio-economic criteria over a mean follow-up time of 4.5 years. Since no conservative treatment exists, an improvement in therapeutic results can only be achieved by early diagnosis using magnetic resonance imaging and operating when the disease is still at an early stage.