[Objective] To select different hip preservation methods in adult patients with femoral head necrosis and analyze the pros and cons of its application. [Methods] Retrospective analysis of 176 patients with femoral head necrosis (ONFH) admitted to our joint surgery department from February 2017 to March 2019, and patients in group F received surgical treatment with vascularized fibula graft (FVFG) (92 cases) In Group T, patients underwent tantalum rod implantation (TRI) (84 cases). [Results] The operation time, intraoperative blood loss and hospitalization time of group F patients were significantly lower than those of group T; at the last follow-up, the Harris Harris score and Harris score excellent rate of group F patients were significantly better than group T; group F The VAS and WOMAC scores of hip joints of patients were significantly lower than those of group T; the incidence of adverse reactions in group F was significantly lower than that of group T (both P<0.05). The anteversion angle, artificial acetabular abduction angle and rotation wheelbase of group F were significantly better than those of group T (P<0.05).[Conclusion] The use of FVFG in the treatment of adult ONFH patients can effectively improve the clinical symptoms of patients, block the process of femoral head collapse, effectively reduce the incidence of surgical trauma and postoperative adverse reactions, and then achieve the effect of improving short-term efficacy. Therefore, it is recommended that FVFG surgical treatment be given priority when economic conditions permit.