Objective To investigate the short-term efficacy of this method in the treatment of adult femoral head necrosis by retrospectively analyzing the clinical and imaging outcomes after minimally invasive medullary core decompression + disease-clearing bone graft + porous tantalum rod support via a small lateral femoral incision. Methods Fourteen adult ANFH patients (19 hips), l2 males and 2 females, with a mean age of 36.2 (22-51) years, were selected from ACRO stage I I IIIA. The surgical approach was minimally invasive medullary core decompression + disease-clearing bone grafting + porous tantalum rod support via a small lateral femoral incision, with complete disease clearance + adequate bone grafting under accurate intraoperative C-arm positioning. The follow-up period was 6-20 months. Paired t-test of Harris score before and after surgery and imaging changes of the femoral head of the affected limb were observed and evaluated to derive the femoral head survival rate at 12 months after surgery. Results One case (1 hip) was lost to follow-up. Among the 13 cases with 18 hips at follow-up, the Harris scores of the affected hip before and 12 months after surgery were (52.12±2.63) and (80.21±4.32), respectively (P<0.05), with significant differences; 2 cases (3 hips) had worsened on imaging x-ray review, and 1 case (1 hip) had undergone hip arthroplasty at an outside hospital 12 months after surgery. The survival rate of femoral head was 89.95% with femoral head collapse or total hip replacement as the study stopping point. Conclusion Minimally invasive medullary core decompression + disease clearing bone grafting + porous tantalum rod support via a small lateral femoral incision for femoral head necrosis is a more effective solution for head preservation treatment of femoral head necrosis, and intraoperative thorough disease clearing + adequate bone grafting is a key step that cannot be ignored in surgery.