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Objective: Retrograde drilling of a necrotic zone within the femoral head to reduce intraosseous pressure and stimulate revascularization., Indications: Atraumatic osteonecrosis of the hip ARCO stage I (reversible) and ARCO stage II (potentially reversible) with a medial or central necrotic zone <30% or ARCO stage III with a subchondral fracture for reduction of pain., Contraindications: ARCO stage III C, ARCO stage IV (secondary osteoarthritis), stage-independent necrotic zone > 30%, infections., Surgical Technique: Supine position. Visualization of the necrotic zone via an image intensifier, approach is determined by using a Kirschner wire, laterodorsal skin incision on a level with the wire, longitudinal incision of iliotibial band and vastus lateralis muscle, drilling the necrotic zone with a 2-3 mm Kirschner wire, optionally placing more wires or a hollow drill, wound closure., Postoperative Management: Partial weightbearing with 20 kg for 6 weeks due to risk of fracture, followed by avoidance of jumping or sprinting for another 6 weeks; physiotherapy from day 1 after surgery, thromboembolic prophylaxis until full weightbearing is possible., Results: Results are dependent on ARCO stages and are promising in early stages.