Abstract】Objective To study the treatment of non-traumatic ischemic necrosis of the femoral head in adults with extracorporeal shock wave therapy (ESWT). Methods The 69 cases in this group were all in Ficat stage I~III, treated by high energy orthopedic shock wave therapy machine with energy density 0.18-0.25mJ/mm2, using the femoral head necrosis area and its adjacent bone as the impact point, with a total of 4000~6000 shocks, and a total of 6~8 treatments were done. The affected hip was free from weight-bearing for three months, and weight-bearing was reduced for six months. In all cases, MRI examinations (also measuring the percentage of femoral head volume occupied by the necrotic area), hip Harris score (100 points), and bilateral hip X-ray were performed before, at 3 months, 6 months and 12 months after treatment. Statistical processing. After 1-year follow-up, the percentages of necrotic area in the femoral head volume before and 3, 6, and 12 months after shock wave treatment were 49.9%, 19.6%, 6.8%, and 5.6%, respectively, and the mean hip Harris scores were 47.2, 77.9, 90.2, and 92.2, respectively; bilateral hip radiographs showed no deformation of the femoral head in each group after treatment. There was no femoral head deformation or collapse after treatment compared with that before treatment. The percentage of the necrotic area in the femoral head volume and the Harris score of the hip joint were significantly different in each stage after shock wave treatment compared with those before shock wave treatment (P<0.01). Conclusion Extracorporeal shock wave therapy for non-traumatic ischemic necrosis of the femoral head in adults has significant efficacy, non-invasive, and low treatment cost, and this method will become the main method for clinical treatment of this type of disease. However, further studies on its mechanism of action and the optimal treatment method are still needed.