BACKGROUND: For the Ficat Ⅱ of femoral head necrosis especially with osteoporosis, core decompression with or without acellular tissue engineered bone can result in a higher incidence of femoral head collapse. OBJECTIVE: To analyze the clinical effect of core decompression plus implantation of acellular tissue engineered bone with titanium rods in the treatment of early necrosis of the femoral head. METHODS: Thirty-five hospitalized patients with early necrosis of the femoral head (40 hips) were enrolled in the study and assigned into a observation group (15 cases with 20 hips, including 10 hips of Ficat I, 10 hips of Ficat Ⅱ) and a control group (20 cases with 20 hips, including 11 hips of Ficat Ⅰ, 9 hips of Ficat Ⅱ). Core decompression plus implantation of acellular tissue engineered bone with titanium rods were conducted in the observation group, while Bouche decompression with implantation of acellular tissue engineered bone was done in the control group. All the patients were followed up for 1 year. Visual analogue scale (VAS) score, Harris hip function score, and progression in necrosis of the femoral head were compared between two groups. RESULTS AND CONCLUSION: VAS scores and Harris scores at 1-year follow-up in both groups showed better outcomes (P ＜ 0.001). At the end of 1-year follow-up visit, the Harris score was significantly higher in the observation group than the control group (P＜0.05), while there was no difference in the mean VAS scores between the two groups (P ＞ 0.05). For Ficat II patients, the excellent/good rate in the observation group was higher than that in the control group at the last follow-up (80% vs. 40%, P＜0.05). According to the Ficat staging, the effective rate in the observation group was higher than that in the control group (90% vs. 80%, P＜0.05). During the postoperative 1-year follow-up visit, Ficat Ⅰ patients presented with better repair of lesions, no degeneration of the hip joint, and no subchondral bone collapse. Overall, it is an effective treatment for early necrosis of the femoral head by core decompression plus implantation of acellular tissue engineered bone with or without titanium rods; however, co-implantation with titanium robs can show better short-term outcomes.