1, systemic anticoagulation to improve microcirculation: Glueck believes that femoral head necrosis is in part due to congenital genetic or acquired thrombosis and or low fibrinolysis leading to femoral head venous thrombosis, increased intraosseous venous pressure, and then arterial blood flow decreases causing osteoclastic death by lack of oxygen. Therefore, before irreversible collapse of the femoral head occurs at an earlier stage of ischemic necrosis, the process of femoral head necrosis can be reversed, stopped or delayed by anticoagulation, improving intraosseous microcirculation and correcting the hypercoagulable and hypofibrinolytic state. Low-molecular-weight heparin (including natriuretic heparin and enoxaparin) is widely used as an anticoagulant in clinical practice, and Glueck [1] considered the efficacy of anticoagulation with enoxaparin satisfactory for early osteonecrosis (Ficat stage I or II). He treated 23 patients (14 males and 9 females) with enoxaparin for 12 weeks (60 mg/day) and followed up for 108 weeks. Norman [18] used enoxaparin in a rat model of osteonecrosis and demonstrated that low-molecular-weight heparin not only has anticoagulant effects to prevent osteonecrosis, but also has direct effects on osteoclasts to promote resorption of dead bone and inhibit the inflammatory response to promote transangiogenesis. However, the long-term effects of low-molecular-weight heparin on osteonecrosis have been shown. Folwarczna [19] et al. found that the application of standard molecular weight heparin and natriuretic heparin both caused osteoporosis due to reduced mechanical loading of the femoral neck, while the application of enoxaparin was more significant, and the mechanism may be related to its inhibition of bone formation and enhancement of bone resorption.2. Local intervention to promote osteogenesis: hormonal osteonecrosis It may be an osteoblast/osteoclast disease, so transplanting bone marrow containing osteogenic progenitor cells into the area of femoral head necrosis and promoting osteogenesis may be beneficial to the treatment of osteonecrosis. Hernigou P [20], a French scholar, conducted a retrospective study of 116 patients (189 hips) with osteonecrosis of the femoral head treated with marrow decompression plus autologous bone marrow cell transplantation and found that only 44 hips collapsed during 5-10 years of follow-up, and confirmed that the higher the number of osteogenic progenitor cells in the implanted bone marrow, the better the prognosis. A Belgian scholar, Gangji V [21], applied autologous bone marrow single nucleated cell transplantation plus medullary decompression to treat femoral head necrosis in 13 patients (18 hips) with ischemic necrosis of the femoral head (ARCOI or II) and showed that after 24 months, the patients in the experimental group (10 hips) showed significant improvement in pain symptoms and joint function, and only one patient progressed to stage III; whereas in the control group (8 hips) with decompression alone, five patients progressed to stage III. 8 hips) had 5 cases progressing to stage III, and there was a significant difference in the analysis of the survival time to collapse between the two groups. This all suggests that autologous bone marrow mesenchymal cell transplantation is an effective and safe approach for early stage femoral head necrosis. mont suggested that bone formation protein (BMP) has the ability to promote the growth and differentiation of bone marrow stem cells into bone and therefore local application in the femoral head may be beneficial in promoting the repair of osteonecrosis, as confirmed by the study of Valentin-Opran [22]. He applied rh-BMP-2 plus medullary decompression to treat 24 cases of osteonecrosis (FicatI or II) compared with medullary decompression alone, and found that the degree of progression in the rh-BMP-2 treatment group was significantly lower than in the medullary decompression group alone, and significantly fewer joint replacements were required.3 Regulation of lipid metabolism disorders: Statin lipid-lowering drugs can regulate hormone-induced disorders of lipid metabolism. Wang GJ has conducted a series of studies since 1995 to confirm the therapeutic effects of hormone-induced osteonecrosis and lovastatin. He demonstrated by cell culture that lovastatin could inhibit hormone-induced adipose gene expression in bone marrow stromal cells and counteract the effect of hormone inhibition of osteoblast gene expression, and that lipid-lowering drugs (e.g., statins, high molecular weight fatty acid D-003) could promote high expression of BMP-2 not only in osteoblasts, but also in bone marrow stromal cells, and promote Pritchett JW [23] observed the incidence of osteonecrosis in 284 patients on high-dose hormones in combination with statins, and found only a 1% incidence of osteonecrosis at a mean follow-up of 7.5 years, which is much lower than the 3% to 3% incidence of femoral head necrosis reported in the literature for patients on high-dose hormones. This is much lower than the 3% to 20% incidence of osteonecrosis in patients with high-dose hormone use reported in the literature. Therefore, it is proved that statins can prevent the occurrence of hormonal osteonecrosis.4. Physical therapy: interventional treatment in this area mainly includes high-frequency oscillatory waves, electromagnetic field physiotherapy (pulsed electromagnetic field), and hyperbaric oxygen therapy.Ludwig [24] treated 22 patients (10 women and 12 men) with high-frequency oscillatory waves for one year for osteonecrosis of the femoral head (ARCOI-III), and used the improvement of clinical symptoms and MRI was used to assess its efficacy and showed that the pain score decreased from 8.5 to 1.2 and the Harris score increased from 43.2 to 92, but MRI showed no disappearance of the sclerotic zone around the necrotic bone. Pulsed EMF therapy was first reported by Eftekhar NS (1983) to be effective in early femoral head necrosis, and its effectiveness was confirmed by many clinical studies later. The follow-up revealed a significant improvement in clinical symptoms and no further deterioration in imaging, demonstrating the effectiveness of pulsed EMF for early ischemic necrosis of the femoral head. Reis ND [26] concluded that hyperbaric oxygen was effective in treating stage I ischemic necrosis of the femoral head by treating 12 cases of ischemic necrosis (stage I) with hyperbaric oxygen. The application of these therapeutic measures is currently controversial because although they can relieve the spontaneous pain of early osteonecrosis and improve clinical symptoms in the short term; their efficacy in preventing the progression of osteonecrosis in the long term remains to be proven [27].5. Anti-osteoporosis and anti-oxidative stress: anti-osteoporosis drugs bisphosphonates such as zoledronic acid and alan phosphate sodium can treat and prevent glucocorticoid-induced osteoporosis [28].Agarwala used alendronate to treat patients with osteonecrosis with good results.Agarwala reported the efficacy of phosphonates in ischemic osteonecrosis through a prospective study. He treated 100 patients (most with hormone-induced) with alendronate 10 mg/day or 70 mg/week with calcium (500-1000 mg) and vitamin D adjuvant, with follow-up from 3 months to 5 years, showing a significant decrease in pain and functional scores, a significant increase in walking and standing time, and a significant improvement in joint mobility in the first year, with MRI showing that most patients Ichiseki T concluded that hormone-induced oxidative stress not only damages vascular endothelial cells but also directly damages osteoblasts, so the application of antioxidant stress agents along with hormones may help prevent osteonecrosis, and he demonstrated in a rat model that GSH, an antioxidant emergency drug, reduces the occurrence of osteonecrosis[10] . . Interventional treatment in the early stages of osteonecrosis is an effective means of preserving the femoral head, and these measures have achieved some short-term efficacy such as pain relief and improvement of joint function, but the long-term efficacy of all these measures remains to be confirmed by further observation. As the etiology of osteonecrosis is further elucidated, more effective measures may be found to prevent or reverse early osteonecrosis.