Purpose: The extracapsular placement of a vascularized fibular graft in the subchondral region of the femoral head is a widely accepted method for treating patients with avascular necrosis (AVN) of the femoral head. The “Ioannina method” is a technique, which aims to improve the precision of targeting the lesion of the femoral head, thus increasing the survival of the femoral head in patients with osteonecrosis. Material-Methods: Twenty-seven patients (30 hips) with femoral head osteonecrosis were treated with this technique in our Orthopaedic Department during the last four years. With use of CAD-CAM the lesion is located and a custom-made metallic aiming device is manufactured. This aiming device is then used to place the graft in its optimal position in the center of the lesion. This group was compared with 20 patients with conventional targeting. Results: Results were evaluated clinically and radiologically. The short-term results showed precision of targeting in 89% of the patients, compared to 55% with the conventional method. X-ray exposure and operative time were also significantly reduced. Conclusions: This technique is the result of more than 12 years of experience in the treatment of osteonecrosis with transfer of free vascularized fibular graft. It was designed and developed by the first of the authors and expresses the contemporary trend for precision in location and description of the lesion. It decreases X-ray exposure, minimizes operative time and optimizes the placement of the graft. Key words: femoral head osteonecrosis, free vascularized fibular graft, CAD-CAM