The effect of medication alone in the treatment of femoral head necrosis is the least desirable and definitive, and the efficacy of surgical treatment is more definitive than that of medication alone. There are more surgical options for head-conserving treatment of femoral head necrosis, such as medullary decompression, medullary decompression combined with bone grafting, medullary decompression combined with tantalum rod implantation, osteotomy around the femoral rotor, bone graft without blood supply and autologous bone graft with blood supply (e.g. iliac flap graft with blood vessels, fibula graft with blood vessels), etc. Among the many treatment options, marrow core decompression has the longest history and proven efficacy, and various types of marrow core decompression techniques based on marrow core decompression have received the most attention because they are less invasive, can be performed minimally invasively, and patients recover quickly with fewer complications. For other types of surgical options, such as fibula graft with blood vessels, the author does not recommend them because of the high surgical trauma and complications.