This study aims to evaluate the clinical efficacy of core decompression with bone grafting combined with perifemoral arterial infusion (CDBG-AI) in treating stage I-II osteonecrosis of the femoral head (ONFH). A total of 40 patients (40-70 years old) with stage I-II ONFH were enrolled. Initially, these patients underwent core decompression plus implantation of allogeneic bone and CaSO4 particles; 5-7 days later, they received arterial perfusion of a thrombolytic drug and vasodilator into the exterior and interior femoral circumflex arteries, obturator artery, and inferior gluteal artery; the perfusion was repeated at the 3rd, 6th, and 12th postoperative month. Imaging changes in the femoral head were observed 1 year later; the visual analogue score (VAS) was used to evaluate symptom improvement, and the Harris score was used to evaluate function. Among the 40 patients, signs of necrosis disappeared in four cases, 32 cases showed no changes on imaging, and four cases progressed to stage III; the VAS scores showed symptom relief in 36 cases, but four cases showed either no relief or aggravated symptoms; the Harris scores showed improvement in 36 cases, and worsening condition in four cases. Routine CDBG-AI could effectively improve the prognosis of less than stage II ONFH and delay its progression.