Ischemic necrosis of the femoral head is a difficult orthopedic disease with a high disability rate. Without early and timely treatment, most patients eventually experience severe loss of hip function and require artificial joint replacement surgery. Although great progress has been made in artificial joint replacement in terms of prosthesis preparation process and surgical operation design, the common life span of artificial joints is more than ten years, during which the prosthesis may break, loosen, joint infection and other accidents, so there are still many problems for young patients to use joint replacement, which may require multiple revision surgeries and increase the physical, mental and economic burden of patients. Therefore, how to delay or even avoid artificial joint replacement has become the focus of research on the treatment of ischemic necrosis of the femoral head. At present, according to the different stages of ischemic necrosis of the femoral head, the following treatment options are mainly available clinically: I. Non-surgical treatment For patients with ARCO stage I or stage II type A, conservative treatment can be adopted. Protective weight-bearing is the method that must be chosen. Walking on crutches, bed rest and appropriate traction during the onset of the disease can relieve pain, but there is still controversy in the medical community as to whether further collapse of the femoral head can be prevented. Hyperbaric oxygen and extracorporeal shock waves are helpful in promoting the repair of osteonecrosis. At present, there are no specific drugs for the treatment of osteonecrosis of the femoral head. Non-steroidal anti-inflammatory drugs can relieve the hip pain, and blood vessel dilation and blood circulation activating drugs can partially improve the blood flow in the femoral head area. II. Medullary core decompression Scholars at home and abroad have reached a consensus on the treatment of early ischemic necrosis of the femoral head – medullary core decompression. This treatment method is mainly applied to patients with ARCO stage I and II. The purpose of this procedure is to restore the normal blood flow in the femoral head by reducing the pressure in the medullary cavity of the femoral head, and to reduce the pain caused by this procedure. Some scholars also performed bone, osteoclastogenic factor or autologous bone marrow cell transplantation at the same time of marrow core decompression, which was thought to further improve the surgical results. Although there are some differences between the results of various studies, the consistent conclusion is that this technique can achieve excellent results only in early cases of pre-collapsed femoral head. Third, fibula grafting This procedure is mainly suitable for patients with ARCO stage II and III, and is currently advocated by many scholars. The specific method is to make a groove through the neck of the femoral head, completely remove the dead bone, and take about 6 cm of fibula within the femoral head, which also includes two types of surgery: anastomotic vascular and non-anastomotic vascular. The anastomotic fibula graft is more effective in treating early necrosis of the femoral head. Patients showed significant improvement in postoperative pain, claudication and the need for bracing. This procedure is mainly suitable for patients with ARCO stage II and III. The purpose of open-hole lesion removal bone grafting is to reduce intraosseous pressure, promote venous return and improve blood supply to the femoral head through lesion removal; implanting autologous or allogeneic bone in the cavity of the lesion area is to provide bone material for bone repair, reconstruct bone trabeculae, support the joint surface and prevent femoral head collapse. The specific method is to remove the dead bone through a window at the neck of the femoral head and take autologous cancellous bone or allogeneic bone to fill the defect. This surgical method is simpler than bone flap grafting with vascular tips, but the survival and osteoinduction ability of new bone implantation in the femoral head with poor blood flow is not satisfactory. V. Bone flap transfer with vascular tip This procedure is mainly applied to patients with ARCO stage II and III, and it is a more popular and effective treatment. The procedure is performed by removing the dead bone through the neck of the femoral head and filling the defect with a vascularized iliac bone block or a greater trochanter bone block, and the surrounding space is filled with autologous bone or allogeneic bone. The theoretical basis of this method for the treatment of ischemic necrosis of the femoral head includes the following: the removal of dead bone from the femoral head reduces intraosseous pressure and removes barriers for hematologic reconstruction and reossification; the transplantation of “living bone” with blood flow increases blood flow and osteogenic effector cells in the femoral head, and the reconstruction of the femoral head defect area through new bone growth without the need for a long crawling replacement process. The implanted bone can provide mechanical support and reduce the risk of femoral head collapse; the graft has an independent arteriovenous system, which can establish a connection with the blood flow around the lesion and rebuild the blood supply in the femoral head. Hip arthroscopy-assisted treatment of femoral head necrosis Hip arthroscopy technology has brought new methods for the treatment of ischemic necrosis of the femoral head. At present, nearly ten hospitals in China, such as Liu Yujie, Wei Xiaochun and Zhao Dewei, have performed hip arthroscopy-guided medullary decompression of ARCO Ι~Ш stage aseptic necrosis of the femoral head with multiple orifices, while performing hip synovial cleaning, joint washout, broken cartilage and free body removal surgery. Some hospitals also perform hip arthroscopy-guided subtrochanteric decompression, dead bone scraping, and autologous cancellous bone grafting. This has improved the therapeutic effect in a minimally invasive way, indicating that the application of hip arthroscopy technology has become more mature. If the necrosis of femoral head is not effectively treated at an early stage, the condition will further deteriorate and develop into ARCO stage IV, i.e. osteoarthritis stage. At this stage, the femoral head collapses, the joint space disappears, the femoral neck shortens, the joint pain occurs, the joint cannot move, the joint function is lost, and artificial hip replacement is inevitable. For the treatment of ischemic necrosis of the femoral head, we advocate: early detection and early treatment. The earlier the staging, the less damage and the better the effect of treatment. We hope we can fully understand the serious consequences caused by femoral head necrosis.