Many patients have had excellent therapeutic results with core decompression for osteonecrosis of the femoral head. However, this experience has not been uniform and shows considerable variability in both clinical and radiographic results that have been reported. Additionally, it is now apparent that core decompression has minimal usefulness in Ficat III lesions presenting with or without collapse. A variety of techniques have been examined to reduce the variability and extent the range of core decompression. These techniques collectively seek to enhance bone formation and/or decrease bone resorption with the goal of maintaining structural integrity of the femoral head and preventing segmental collapse. This review describes some of these efforts with bone grafts, demineralized bone matrix, bone morphogenic proteins, and electric and electromagnetic fields. Our personal experience with demineralized bone matrix and electromagnetic stimulation is described. These techniques use core decompression as a portal to the necrotic zone in the femoral head for the introduction of materials, devices, and techniques by which bone formation may be stimulated.