Avascular necrosis (AVN) of the femoral head, which may lead to progressive degenerative joint disease when left untreated, is particularly seen in young adults. Patient`s age, aetiology of the disease, size and location of the lesion, sphericity of the femoral head, and degenerative changes of the femoral head should be evaluated during management approach for the AVN of the femoral head. Sphericity of the femoral head is the major determinant in the clinical decision-making process. Joint preserving treatment modalities are applied when the sphericity of the femoral head is intact. Main objective of joint preserving techniques relies on debridement of the necrotic tissue and induce a regenerative process to fulfil the osseous defect. Core decompression, vascular or avascularized bone graft, proximal femoral osteotomies, and mesenchymal or adipose tissue-originated stem cell transfer are among the joint preserving treatment modalities. However, total hip arthroplasty is the only surgical option in cases with loss of femoral head sphericity and collapsed cartilage of the femoral head. Despite of the current developments, ideal treatment method has not been established yet.