In my daily clinical work, I am consulted by patients on this issue almost every day, and many of them have been torn for a long time, uncertain about what to do, which not only delays their illness, but also affects their health, wasting time and money. But it is hard to blame them, because not only the doctors of different levels of hospitals say different things, but also the doctors of the same level of hospitals say different things, and even different doctors of the same hospital say different things. In 2009, the author met a middle-aged male patient who visited more than 20 hospitals in a row in one month, including 8 tertiary hospitals, resulting in 8 treatment plans in 4 categories, including non-surgical treatment, minimally invasive bone graft surgery, bone flap transplantation with blood vessels, artificial joint replacement, etc., leaving this patient at a loss. And it is very easy to get information about various diseases from the Internet and other channels, perhaps because of the need for competition in the medical market, various high-profile publicity often gives patients the illusion that many difficult diseases are no longer difficult in today’s increasingly prosperous world of medicine, and there is more than one cure, and each “cure” is said to be the The more you look at them, the more confused you are and the more tangled you become. Objectively speaking, the treatment of femoral head necrosis, especially the treatment of preserving one’s own hip joint after collapse (referred to as “hip preservation”), is still one of the most challenging tasks in orthopedics, not only in China but also in other countries around the world. The success rate of all available treatments, if applied indiscriminately, does not exceed 50%. Therefore, the real expert in femoral head necrosis is not the one who has mastered any magical method, but the one who first knows how to choose, knows which patients can be treated without treatment, which patients can be treated non-operatively, and which patients must be operated as soon as possible; which patients can be treated with minimally invasive surgery, and which patients need to be treated with repair and reconstruction of exposed joints; which patients can be deferred for joint replacement, and which patients’ joints are not The second thing is to know how to choose based on the following The second is to master the full set of treatment techniques from non-surgical, to minimally invasive surgery, to traditional repair, to reconstructive surgery, to artificial joint replacement (from initial to revision), etc. on the basis of knowing how to choose. Unfortunately in China, there are too few doctors like this, and they are far from meeting the clinical needs. To return to the question of whether it is better to “replace the joint” or “preserve the joint” after the collapse of femoral head necrosis, the first thing is to have a correct understanding of the collapse. The degree, extent and site of collapse are important, but the time of collapse, the trend of current and future effects of collapse on the patient (symptoms, hip mobility, joint stability, etc.) are also important, if not more important, but it is precisely the latter that does not receive sufficient attention. Conclusion: The clearer the understanding of the collapse and the more accurate the judgment of the collapse trend, the more reliable the choice of “joint replacement” or “joint preservation” will be, otherwise, there will be either a missed opportunity, or excessive medical treatment, or wrong treatment. In either case, it is very regrettable and frustrating.