Early diagnosis of femoral head necrosis is very difficult, mainly because there are no typical symptoms or no symptoms at all, and once detected, it is no longer early, so in the coming years, early diagnosis of femoral head necrosis will remain a problem to be solved. So what is the specific level of “early” for the general population? According to Ficat and Arlet’s staging method, early stage should be when there is no abnormality or only a slight abnormality visible on plain radiographs, while it is visible on MRI, although the extent of necrosis may vary. In clinical practice, we often encounter cases where there is necrosis on MRI and the patient does not feel anything, so some people suspect that they have taken the wrong film. What to do? Once it is determined to be femoral head necrosis, doctors, patients, and family members are torn about the issue. The first reaction may be to take another look at a different doctor or a hospital, praying that the initial doctor is mistaken. If everyone is sure of the diagnosis, the next step is to ask around for “secret” or “partial” remedies, so to speak, “to seek medical help when there is a disease”. Most patients will not accept the surgical treatment recommended by their doctors, especially if they do not have any clinical symptoms yet. The vast majority of “early stage” patients progress through a variety of non-surgical treatment options, with only a few patients having their disease controlled or terminated in the short term. Why choose “borehole decompression surgery”? Up to now, the accepted theory is that the process of femoral head necrosis is exacerbated by multiple pathological factors that increase the pressure inside the femoral head. “. If such pathological changes are not relieved or eliminated, it is theoretically impossible to stop the course of femoral head necrosis. Will “borehole decompression surgery” work? There are several points that can be answered with certainty: 1) the patient’s hip pain will be relieved or disappeared immediately after the decompression surgery; 2) the decompression provides a “drainage” channel to the closed space; 3) the decompression tunnel provides a way for the new blood vessels to grow in. So when should we perform “borehole decompression surgery”? The sooner the better. The following problems cannot be solved yet and need to be given sufficient attention: 1 The etiology and pathology of each patient are different, so the extent of necrosis is also different, and it is impossible to completely solve the boundary determination of osteonecrosis and define the extent of osteonecrosis in a single volume. 2 According to the existing anatomical knowledge, the distribution of well-known blood vessels in the femoral head is known, but the blood supply status of the traffic area between the major vessels is still not determined. remains undetermined. Individual differences or variations have a significant impact on the final extent of osteonecrosis.3 The location and number of boreholes and their diameters are not uniformly conclusive. There can be deviations in the surgeon’s operative technique.4 The degree of understanding of osteonecrosis and variability in the accuracy of the surgeon’s surgical operation can have a significant impact on the regression of osteonecrosis of the femoral head.5 The repair pattern of osteonecrosis may be variable. Early “borehole decompression surgery” is recommended for early osteonecrosis of the femoral head, but it is not the only method, as interventional treatment must be combined with other treatments, such as weight reduction, Chinese herbal medicine, and local physical therapy. It is necessary and wise to review the disease regularly to understand the degree of progress. In clinical practice, there are not a small number of cases where patients have been treated and the degree of necrosis continues to get progressively worse.