Experts call for the difficulty in determining when to treat osteonecrosis of the femoral head by vascular intervention in our country, but in fact it has taken the country by storm. Throughout the world, including Japan, the United States, South Korea and other countries with very in-depth research on osteonecrosis, there is no such treatment. Is it a blessing or a disaster for the patient that our country is alone in this endeavor? The time has come when we must face up to it. Interventional means of treating osteonecrosis of the femoral head is mainly concentrated in the radiological community, and orthopedic surgeons are less likely to implement it, and are skeptical about the basis and efficacy of the treatment. The use of this method for the treatment of femoral head necrosis is mainly concentrated in small and medium-sized hospitals and staff hospitals, and is less frequently implemented in large teaching hospitals. Although a few papers have been published so far, they are limited to local journals, and domestic mainstream journals are still cautious. From the papers published so far, none of them can stand up theoretically, and none of them is a summary of the medium and long-term efficacy according to the evidence-based medical method, and most of them are just speculation. First, the interventional treatment of femoral head necrosis is theoretically untenable. Femoral head necrosis is divided into two categories: trauma and non-trauma. The former reason is clearer, that is, femoral neck fracture or hip dislocation, etc. damage the femoral head weight-bearing area of the main nutrient vessels DD epiphyseal arteries and veins caused, while the latter etiology is still being explored in depth, presumably corticosteroids, alcohol direct action or its metabolites in the body damage the bone marrow endothelial cells, causing the bone marrow vascular embolism leads to osteoblasts and bone marrow vascular embolism leads to the death of bone cells and bone marrow components. However, whether arterial embolism precedes or is secondary to venous embolism is still debated. Perhaps the advocates of interventional treatment of femoral head necrosis were inspired to implement thrombolytic therapy for myocardial infarction and cerebrovascular embolism. The use of pharmacological thrombolysis for cardiovascular embolism does have excellent efficacy. However, the timing of treatment must be mastered. It has been reported that myocardial infarction should be treated within 12 hours of onset, while treatment efficacy is best within 2-3 hours and decreases with time. In contrast, the time window for treatment of cerebrovascular thrombosis is 3 hours for intravenous thrombolysis and 6 hours for arterial thrombolysis. If the above time limit is exceeded, the treatment will be changed to other methods. Even if it is certain that the femoral head necrosis is caused by embolism of small arteries in the bone, according to the current level of diagnosis, the shortest interval between the start of corticosteroid osteonecrosis medication and a positive magnetic resonance imaging (MRI) (stage I) is 4 weeks, according to the latest data. Since most of the osteonecrosis of the femoral head has no clinical symptoms and signs in the early stage, it is difficult to alert patients and physicians. Waiting for the appearance of symptoms such as hip pain and claudication, or waiting until X-rays and CT scans show positive changes, the shortest interval is 6 months according to our study on the natural history of osteonecrosis in SARS (natural history). The use of intravenous perfusion control agent powered MRI scan can be explored to show arterial perfusion changes within 72 hours after drug administration, but it is still in the animal experimental stage, and further research is needed to apply it to clinical diagnosis. Angiography of stage II and III femoral head necrosis showed that the necrotic area was not visualized at all, suggesting the absence of blood circulation in this region (Figure 1). Therefore, the interventional method of injecting all kinds of thrombolytic drugs approved by the State Food and Drug Commission (CFDA) cannot enter the necrotic zone without blood vessels, and dissolving the long-established thrombus to achieve the therapeutic effect is undoubtedly lack of scientific basis, unless people with ulterior motives claim to use the so-called partial prescriptions, experimental prescriptions, and ancestral secret recipes to deceive patients. Second, clinical practice has proved that interventional treatment of femoral head necrosis is ineffective according to the admission of medium and late stage femoral head necrosis, about 1/3 to 1/2 of the patients have received interventional treatment, the most for 4 times. In these patients, the femoral head eventually collapsed and seriously affected joint function, necessitating artificial joint replacement. Even in early cases (stage I), interventional treatment was ineffective. Eight cases of post-SARS osteonecrosis treated at our center, all diagnosed within 3 months after the application of high-dose corticosteroids, were treated with interventional therapy, which showed that these patients were ineffective in the early stage (pain persisted or worsened) and progressed to stage II or III in the middle stage, and were treated with joint-preserving surgery. If interventional treatment is performed in patients with stage I or II femoral head that has not yet collapsed, presumably the starting point is good from good intentions, but the end result is still contrary to what is desired. Some authors insist on interventional treatment in some patients with femoral head necrosis that has reached stage III (beginning of collapse) or stage IV (joint damage), which is inappropriate and ineffective (Figure 2). Femoral head necrosis is a progressive disorder. Once the femoral head is necrotic, the repair mechanism in the body causes the intramedullary vessels to gradually enter the necrosis in an attempt to repair the necrotic area. However, the body’s ability to repair itself is limited, and in the case of ischemia, a sclerotic zone often forms at the edge of the necrotic area, which can be clearly shown on a CT scan. Once the sclerotic zone is formed, it means that the self-repair stops, and without surgical or other invasive means (e.g. extracorporeal shock wave) intervention, the necrotic area cannot be repaired, and even interventional treatment is ineffective (Figure 3). Interventional treatment of femoral head necrosis is not only ineffective but also harmful. At present, the commonly used method in China is to enter the selected internal femoral artery through the femoral artery cannula to inject drugs, and the cannulation process can damage the endothelial cells of blood vessels and also form inguinal hematoma after extubation, which can cause pain to patients. The complication of peripheral tissue bleeding during arterial thrombolytic therapy should not be ignored either. As for the economic loss, it is even more disastrous. The cost of each intervention is around 10,000 yuan. Some patients spend all their savings on the interventional treatment, and some even sell their properties and become heavily indebted, but when they really need to do joint preservation surgery or advanced artificial joint replacement, they are already empty-handed and have to give up the treatment. Such a tragic situation is heartbreaking, but also angry, helpless. Here I cautiously appeal to the conscientious medical staff should take the interests of patients as the first priority, the serious and careful evaluation of the significance and value of interventional treatment of femoral head necrosis. Third, femoral head necrosis should be diagnosed early scientific treatment because the cause of femoral head necrosis is not yet fully understood, so the treatment for the cause is still exploratory and blind. But the consensus of experts at home and abroad is that if the necrosis of the femoral head can be diagnosed early (Ⅰ, Ⅱ), the size of the necrosis area, location and age of the patient, occupation, etc. to develop an individualized scientific treatment plan to save their own joints for 10-15 years, the excellent rate is still in more than 80%. However, the differential diagnosis should be made with other hip diseases. Therefore, it is recommended that high-risk patients suspected of femoral head necrosis (corticosteroid use, alcoholism, hip trauma, high coagulation and low fibrinolytic tendency, etc.) should go to a large hospital for specialist examination as early as possible to confirm the diagnosis and early treatment to avoid detours or deception. Figure 1 Normal femoral head vascular perfusion (a) and III osteonecrosis specimen vascular perfusion (b) Figure 2 Female, 32 years old Corticosteroid osteonecrosis of femoral head (a) bilateral femoral head has collapsed; (b) interventional treatment still done at this stage Figure 3 Male 32 years old October 8, 2003 (a) MRI of both hips showing osteonecrosis (stage II) October 8, 2003 (b) interventional treatment of right hip August 2005 October (c) X-ray shows that the right femoral head still progressed to collapse (stage III).