A reasonable treatment plan should take into account the stage, necrosis volume, joint function, as well as the patient’s age and occupation. Non-surgical treatment of femoral head necrosis It is important to note that the efficacy of non-surgical treatment of ONFH is still unpredictable. I. Protective weight-bearing There is still debate in academia as to whether this method can reduce femoral head collapse. The use of double crutches can effectively reduce pain, but the use of wheelchairs is not advocated. For early stage (0, I, II) ONFH, non-steroidal anti-inflammatory and analgesic agents can be used. For high coagulation and low fibrinolytic state, low molecular heparin and corresponding traditional Chinese medicine can be used, and sodium allantoin phosphate can prevent femoral head collapse. Physical therapy includes extracorporeal shock wave, high-frequency electric field, hyperbaric oxygen, magnetic therapy, etc., which are beneficial to relieve pain and promote bone repair. Surgical treatment of femoral head necrosis Most ONFH patients will face surgical treatment, which includes two types of surgery, including preserving the patient’s own femoral head and artificial hip joint replacement. Surgery to preserve the femoral head includes medullary core decompression, bone grafting, and osteotomy, and is indicated for patients with ONFH in ARCO stages I, II, and early stage III, with a necrosis volume of 15% or more. If the method is appropriate, artificial joint replacement can be avoided or postponed. Osteotomy The necrotic area is moved out of the weight-bearing area of the femoral head, and the non-necrotic area is moved out of the weight-bearing area. Osteotomies used in clinical practice include internal or external osteotomy and transfemoral rotational osteotomy. This method is suitable for ONFH with moderate necrosis volume in stage II or early or middle stage III. This procedure will bring more technical difficulties for the future artificial joint replacement. V. Artificial joint replacement Once the femoral head is heavily collapsed (late stage III, stage IV, stage V), joint function or pain is more severe, the treatment options for different stages of femoral head necrosis For stage 0 non-traumatic ONFH, if one side is diagnosed and the opposite side is highly suspected of stage 0, close observation is advisable, and MRI follow-up is recommended every 6 months. Stage I and II ONFH should be treated aggressively with joint-preserving surgery or medications if it is asymptomatic, non-weight-bearing area, and 15% of the lesion area. Stage IIIA, IIIB ONFH can be treated with each implant osteotomy, osteotomy, limited surface replacement, or conservative treatment for those with mild symptoms. Among patients with stage IIIC and IV ONFH, if the symptoms are mild and the age is young, joint-preserving surgery can be chosen, while other patients can choose surface replacement and total hip replacement.