Abstract Objective The clinical effect of arthroscopic synovium clearance combined with core decompression in the treatment of avascular necrosis of the femoral head was retrospectively analyzed. Methods From January 2016 to December 2018, 52 patients (67 hips) with ONFH were analyzed retrospectively, all of them were in accordance with the international society of bone circulation (Arco) classification of stage I and II of avascular necrosis of the femoral head. According to the different treatment schemes, they were divided into the observation group (arthroscopic synovial cleaning combined with core decompression) and the control group (core decompression alone). Among them, 23 cases (31 hips) were treated in the observation group and 29 cases (36 hips) in the control group. The changes of operation time, hospitalization time, operation complications, visual fuzzy score of pain, Harris score of hip joint function and MRI of hip joint were analyzed. Results ①The operation time and hospitalization time of the observation group were significantly higher than that of the control group (P < 0.01). There was no significant difference in the incidence of complications between the two groups (P > 0.05). VAS and Harris scores of the two groups at the third months after the operation were significantly better than those of the patients before the operation (P < 0.05).③ At the third and sixth month after operation, the VAS and Harris scores of the observation group were significantly better than those of the control group (P < 0.05). There was no significant difference in VAS score between the two groups at the twelfth months after operation (P > 0.05), but Harris score was significantly better in the observation group than in the control group (P < 0.05).The total effective rate of the control group was 69.44%. The total effective rate of the observation group was 93.54%, the difference between the two groups was statistically significant (P < 0.05). Conclusion The treatment of avascular necrosis of the femoral head with arthroscopic synovium clearance combined core decompression could significantly alleviate the postoperative hip pain, increase the accuracy of core decompression, and significantly improve the success rate of hip preservation.