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Young patients with avascular necrosis (AVN) of the femoral head have limited options for the management of their severe pain. The most common treatments include activity modification, core decompression, proximal femoral osteotomies, nonvascularized or vascularized bone grafting, and total hip arthroplasty. Although osteochondral allograft transplantation (OAT) is commonly used to treat cartilage defects in the knee, few studies report osteochondral allograft transplantation in the hip. OAT of the femoral head is an emerging technique that may be an effective option to preserve the hip in young patients with AVN. The manuscript and video review the indications and describes the technique of OAT of the femoral head through an open surgical hip dislocation.