Intertrochanteric osteotomy has a limited but useful role in carefully selected cases of osteonecrosis with small-sized necrotic sectors. In fact, the size of the lesion is a major factor in results from all methods of treatment for osteonecrosis, other than hip arthroplasty. A staging system that incorporates the size of the necrotic sector, such as the Steinberg classification system, is extremely helpful in assessing the outcomes of clinical series. Even initially successful osteotomies most often ultimately require conversion to total hip arthroplasty for the majority of patients. The conversion rate to total hip is approximately 50% at 10 years post osteotomy. Therefore, it is important for surgeons to perform the osteotomy in a manner that facilitates subsequent total hip replacement.