It is estimated that more than 5 million patients with osteonecrosis of the femoral head need treatment in China, and because the treatment of osteonecrosis of the femoral head is very tricky, there is no clinical treatment method that is the gold standard. So the society is full of small advertisements specializing in the treatment of “femoral head necrosis”. One of the ways to treat femoral head necrosis is to replace the artificial joint, but the service life of the artificial joint is about 10-15 years, and patients with femoral head necrosis are often around 30 years old, which makes patients and their families have different degrees of concern. Many patients have to seek medical help for their illnesses, and unruly diagnosis and treatment make them run out of money, and eventually they have to undergo artificial joint replacement. Therefore, only by fully understanding the diagnosis and treatment of osteonecrosis of the femoral head can they be relieved of their psychological burden and get the best results with the least cost. The main causes of femoral head necrosis Femoral head necrosis can be divided into two categories: traumatic and non-traumatic. The latter is mainly caused by the use of corticosteroids (prednisone, dexamethasone, etc.), long-term heavy alcohol abuse and abnormal blood viscosity. However, only 1/3 of the same people who apply hormones and alcohol abuse will develop osteonecrosis, and medically these people are called osteonecrosis susceptible people. The susceptible individuals can be clinically screened by some special blood tests. MRI facilitates early diagnosis Early diagnosis facilitates early treatment, and early treatment is aimed at preserving the patient’s own femoral head as much as possible. This is because most of these patients are very young and often have a polyarticular onset. The current excellent long-term outcome of artificial joint surgery in middle and young adults is still unsatisfactory. According to foreign data, the excellent rate of joint replacement up to 5 years before the age of 40 is only 60%. Preserving the patient’s own femoral head and early diagnosis is the key. According to our research, we found that femoral head necrosis can occur after 1-3 months of using a lot of hormones, therefore, susceptible patients should be examined after 1-3 months of hormone use. Magnetic resonance scan can accurately detect both stage I femoral head necrosis and estimate the necrosis site and area at an early stage, while X-ray and CT scan can only detect it after 9 months to 1 year, when it has mostly progressed to stage II or III. The most serious result of femoral head necrosis is the collapse of the joint surface of the femoral head. The collapsed joint surface is like a broken ball in the axle of a car, which eventually damages the joint. Using magnetic resonance images processed by computer software, the area of necrosis can be accurately calculated and the site of necrosis can be clarified so that it can be predicted which necrotic femoral head will collapse and which will not. 5 steps of femoral head necrosis treatment 1. The staging of femoral head necrosis can be clarified by MRI, and individualized treatment plan can be formulated according to the staging. That is, those who are predicted to collapse should be actively treated and closely observed; those who are not easily collapsed can be treated symptomatically. The femoral head can be preserved as much as possible, and not every patient with femoral head necrosis needs artificial joint replacement, thus greatly saving medical costs and reducing the pain of patients. 2, stage I femoral head necrosis can be non-surgical treatment with a combination of Chinese and Western medicine, such as electromagnetic field, extracorporeal shock wave, etc. have a certain effect. Through a period of treatment, some necrosis can be reversed and some can stop progressing. Of course, reducing weight bearing also has a role in the repair of femoral head necrosis. For early necrosis without pain, bone marrow edema, and bone fracture within the head, as well as necrosis with less than 30% necrosis area, necrosis located in the medial or central type of femoral head (lateral column intact), non-surgical treatment with Chinese medicine as the main treatment can be used, while regular review, many patients can obtain clinical cure. 3. Those with necrosis area over 30% should actively receive surgical treatment to preserve the femoral head. Femoral head necrosis collapse is not equal to the immediate need for joint replacement. For those who have a mild degree of collapse (less than 4mm), with a collapse time of less than 6 months, and who are relatively young, hip preservation surgery such as dead bone clearance, compression implant, fibula support implant or dead bone clearance, compression implant, and bone flap graft with blood vessels can be used to achieve satisfactory results in more than 80% of patients. 4, to progress to the middle of stage III, that is, the joint surface has begun to collapse but the depth is greater than 4mm, the above methods of treatment can also be used, but the efficacy is poor compared to the second stage patients. 5, once the development of necrosis of the femoral head to advanced stage (IV), the joint surface has collapsed, the femoral head has been deformed, joint function damage and pain is more serious, artificial joint replacement is the best choice. In the past decade, with the continuous improvement of artificial joint design and materials, the application of minimally invasive techniques, and the improvement of surgical techniques, the efficacy of artificial joint replacement has been significantly improved, and the use of artificial joints has been significantly extended, and most patients can resume normal life and labor. Therefore, any fear of artificial joint replacement is unnecessary.