Most patients come to the hospital with pain in one side of the hip and after a thorough examination, they find necrosis on the other side as well. So why do they have different symptoms? Let’s take a look at the significance of pain in osteonecrosis of the femoral head! The pain of ischemic necrosis of the femoral head is essentially “intra-capital instability”. This includes intra-capital instability and cartilage instability; i.e., fractures affecting weight-bearing and subchondral separation in the femoral head. In some patients, through weight reduction, physiotherapy, and medication, the femoral head necrosis is repaired and intracapital stability is restored, and good results can be achieved. However, if the extent of necrosis is large and the anterolateral column of the femoral head is involved at the area of necrosis, especially in patients with involvement of the anterolateral wall, the desired results may not be achieved through simple conservative treatment. It is worth mentioning that the reduction of pain during the treatment does not represent a true remission of the disease. If stability is not restored within the head, it may cause further collapse of the femoral head once the patient continues to bear weight.