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Introduction: Osteonecrosis is a progressive disease of hip joint affecting adults in 2nd to 5th decades of life leading eventually to osteoarthritis. Core decompression is one of the modalities of treating pre-collapse stage of Osteonecrosis which entails repair of the necrotic site by coring followed by filling the cored area with a bone graft, which is optional Methodology: 21 patients (34 Hips) in the pre-collapse stage were included regardless of cause of disease and were followed up for a minimum period of 6 months following core decompression. Clinical evaluation was done using HARRIS HIP SCORE and radiological evaluation was done to assess the status of the disease Results: Mean age of presentation was 36.5 years. 18 patients (85.7%) had bilateral involvement and 3(14.3%) had unilateral involvement. 21 patients(34 hips) underwent core decompression. In addition to core decompression, 17 hips (50%) were supported by fibular grafting. 2 hips (5.8%) by bone marrow injection, 2 hips (5.8%) by iliac crest grafting and 1 hip (2.9%) with synthetic bone substitute. Harris Hip Score was at the end of 6 months, 7(20.6%) were graded as excellent, 20(58.8%) as good, 6(17.6%) as fair, 1(2.9%) as poor. Conclusion: Core decompression with or without bone grafting for early stages of Osteonecrosis limits the disease progression, achieves fair to good clinical and radiological outcome, enables the patient to return to their activities of daily living and prevents or delays the need for hip reconstructive surgeries Keywords: Avascular necrosis, core decompression, fibular grafting.