Objective: To compare the clinical efficacy of focused extracorporeal shock wave therapy (fESWT) in the treatment of patients with early and intermediate stages of osteonecrosis of the femoral head (ONFH). Methods: A total of 60 ONFH patients who underwent fESWT treatment in Rehabilitation Department of The First Affiliated Hospital of Hebei Northern University were screened. According to the Association Research Circulation Osseous (ARCO) staging system, the patients were divided into an early-stage group (n=30) and an intermediate-stage group (n=30). The visual analog scale (VAS) for pain, Harris Hip Score (HHS), bone marrow edema (BME), and necrotic area were compared between the two groups. Results：Before treatment, the VAS scores and BME scores in the early-stage group were significantly lower than those in the intermediate-stage group (P<0.01), and the HHS score was significantly higher than that in the intermediate-stage group (P<0.01). After treatment, the VAS and BME scores in both the early-stage and intermediate-stage groups were significantly lower than those before treatment (P<0.01), and the HHS score was significantly higher than before treatment (P<0.01). The differences in VAS, HHS, and BME scores before and after treatment in the early-stage group were significantly greater than those in the intermediate-stage group (P<0.01). Conclusion: Focused shockwave therapy can improve clinical symptoms, restore hip joint function, and promote the absorption of bone marrow edema in the early and in-termediate stages of femoral head necrosis, with better efficacy in the early stage than in the intermediate stage.