In vascularized fibula grafting, the fibula containing the arterial vein of the fibula is surgically removed from the donor area and implanted in the ascending branch of the lateral arterial vein of the rotator femoralis, which is revealed, and the vascularized fibula is implanted in the subchondral bone of the necrotic area through a decompression port and the vessel is connected to the ascending branch of the lateral arterial vein of the rotator femoralis. It is hoped that by implanting the fibula with blood flow to the necrotic area, blood flow to the necrotic area can be re-established. It also provides some support to the subchondral bone of the joint. The procedure is characterized by: (1) two simultaneous procedures, one with hip exposure and the other with harvesting of the ipsilateral fibula with vessels. (2) Under X-ray fluoroscopy, a hole (16-19 mm) is drilled from the distal gluteus maximus crest to the area of femoral head necrosis. (3) Most of the necrotic bone was removed and fresh cancellous bone from the greater trochanter was implanted in the decompression zone. (4) The fibula with the peroneal artery and two veins is inserted via a drill hole 3-5 mm into the subchondral bone area and fixed with a 0.62 mm gristle. (5) The fibular vessels were anastomosed to the ascending branch of the lateral artery and vein of the rotated femur. (6) The surgery was large and two groups were performed simultaneously: one group performed hip exposure and the other group collected the ipsilateral fibula. (7) Complications in the fibular donor area: muscle weakness, discomfort in other parts of the thigh and ankle, and abnormal sensation in the lower extremity. Vail and Lrbaniak reviewed 198 patients (247 hips) and the complications were 19%. (8) The prevalence of lower extremity and ankle pain at 5 years postoperatively was 11.5%. (9) The incidence of proximal hip fractures was 2.5% (18 of 707 hips). (10) It is used in all stages before degeneration of the acetabulum occurs, but is technically demanding and may lead to complications. Fibular graft with vascularization is one of the most clinically proven procedures for the treatment of ischemic necrosis of the femoral head. (i) Yoo and colleagues reported a mean follow-up of 5.6 years in 81 patients, with clinical and radiographic evaluation success rates of 91% and 89%, respectively; (ii) in another review of 40 hips, the authors stated that the radiographic and clinical success rate was 87.5% before femoral head collapse; (iii) Judet and Gilbert reported a mean follow-up of 18 years (range 15 -22 years) in 60 cases (68 hips) after femoral head necrosis surgery, with 52% of the patients being followed up. -22 years), with 52% of outcomes being excellent.