Background: Appropriate treatment of osteonecrosis of femoral head (ONFH) remains challenging. Objectives: Here, we report the results of treating these patients with auto-corticocancellous bone graft from iliac crest to overcome the need for early total hip arthroplasty (THA). Patients and Methods: There were 132 hips (96 patients) with ONFH. Association Research Circulation Osseous (ARCO) type II and III underwent auto-corticocancellous bone grafting from the iliac crest in the current prospective study. Before the operation and in the final postoperative visit, the pain intensity using visual analogue scale (VAS), range of hip motions and Harris hip score (HHS) were determined and compared. Patients were followed for 48.5 ± 17.9 months. Results: The shape of head and the joint space were preserved in 120 hips (90.9%). There were 12 hips in which the disease progressed to grade IV and resulted in THA in 10 of them. The pain intensity significantly decreased (6.3 ± 4.1 vs. 1.4 ± 2) and HHS (35.8 ± 15.3 vs. 79.5 ± 16.2) and range of motion (ROM) significantly improved after the operation (P < 0.001). Conclusions: Necrotic bone removal and filling the femoral head cavity with auto-corticocancellous bone graft from iliac crest is an effective femoral head preserving method in treating patients with precollapse stages of ONFH and preventing the need for early THA, especially in young active populations.