Background: Avascular necrosis of the femoral head is a complex, progressive disease with variable outcomes, primarily affecting young individuals between 30-50 years. While often idiopathic, it can also result from alcohol, steroid use, and femoral neck fractures, particularly in the elderly. Objective: This study evaluated the clinicoradiological outcomes of Quadratus femoris muscle pedicle grafting in patients with osteonecrosis of the femoral head (ONFH), FICAT-Arlet Stage I and II. Methods: The study included 20 patients with ONFH, treated at the Department of Orthopedics, Rajindra Hospital & Government Medical College, Patiala, Punjab. All patients underwent Quadratus femoris muscle pedicle grafting and were followed up clinically using Harris Hip Scores (HHS) at 1 year and radiologically using post-operative radiographs and MRIs at 3 months. Results: After an average follow-up of 1 year: • One patient's hip regressed from Stage II to Stage I. • One patient progressed to Stage III and underwent arthroplasty. • HHS significantly improved in all patients post-surgery (P < 0.05). • Radiographs and MRIs showed no femoral head collapse. • MRI revealed decreased edema signals. Conclusion: Quadratus femoris muscle pedicle grafting is a straightforward surgical technique with: • Low complication rates • Short surgical duration • Relatively short post-operative hospital stay Given its benefits, this technique is recommended for patients with early-stage osteonecrosis (FICAT Stage I and II), provided it is performed meticulously. Recommendations: Further studies with larger sample sizes and longer follow-up periods are warranted to confirm these findings and establish Quadratus femoris muscle pedicle grafting as a reliable treatment option for ONFH.