As one of the earliest hospitals in China to systematically study femoral head necrosis, after 30 years of uninterrupted exploration, the understanding of femoral head necrosis has become more and more mature, whether it is the ability of early diagnosis or the understanding of the most critical pathological changes after necrosis – the prediction of collapse, the occurrence and development pattern of collapse, etc., has made great progress, and the level of diagnosis As for the patients who are most confused about how to choose the most suitable method from the many confusing treatment options, such as traditional Chinese medicine, shock wave, intervention, drilling decompression, various bone grafting (with or without blood vessels), artificial joint replacement, etc., the method has become clearer and more accurate, and the chance of treatment failure due to the wrong choice of treatment method has been greatly reduced. The principle of treatment for femoral head necrosis: “No surgery if non-surgical, no hip replacement if hip preservation (“hip preservation” is short for “preservation of own hip joint”, same below). “The connotation has been continuously enriched and improved, and the clinical efficacy has been continuously improved. The number of blind hip preservation and unnecessary hip replacement has been significantly reduced, and the goal of providing the best treatment to every patient is closer. Specifically, in the Year of the Horse, this is how we diagnose and treat femoral head necrosis. First of all, when a patient is suspected of having femoral head necrosis after medical history and clinical examination (e.g., the patient has a history of long-term alcoholism, high-dose glucocorticoid use, or hip trauma), the patient is asked to take bilateral orthogonal and frog X-rays, and also to have a magnetic resonance imaging (MRI) examination of the hip to confirm or exclude femoral head necrosis. Once the diagnosis of femoral head necrosis is established, the scope of necrosis, the pathological stage, the existence of collapse, the risk of collapse and recollapse, and the stability of the femoral head and hip joint are clarified based on the results of X-rays, MRI, CT and other imaging examinations, and the degree and nature of pain, hip joint function, gait, etc. The patient’s condition is further analyzed by integrating the imaging and clinical examination results, and finally, the patient’s etiology, the cause of the necrosis, and the underlying disease of femoral head necrosis are combined. Finally, we will make a reasonable individualized treatment plan, taking into account the cause, the underlying disease, the general health condition, life expectancy, age, occupation and economic status of the patient. 1. For those who have no pain, no collapse and low risk of collapse, priority should be given to non-surgical treatment with traditional Chinese medicine, and light work should be performed during the treatment period. 2.For those who have no pain and no collapse but have a higher risk of collapse, take non-surgical treatment with traditional Chinese medicine, while limiting the distance of continuous walking, and review every 3 months during the treatment period, if the pain is not relieved and there is aggravation such as collapse during the follow-up period, adjust the treatment plan in time. 3.For those who have pain but no collapse and not much risk of collapse, take non-surgical treatment with Chinese medicine and walk with crutches at the same time, if the pain can disappear for a short time, continue Chinese medicine treatment under close observation, if the pain is not relieved and collapse and other aggravation occurs during the follow-up period, adjust the treatment plan in time. 4.For those who have pain (<6 months), collapse but the degree of collapse is very mild (≤2mm) and the scope is small, use minimally invasive compression support bone grafting, postoperative treatment with Chinese medicine, the affected limb is free from weight-bearing walking for about 6 months, and continue continuous follow-up for not less than 1 year after completely normal walking. 5.For those who have pain (<6 months), collapse and the degree of collapse is more serious (>2mm, ≤4mm), and the scope is larger, adopt incision joint compression support bone grafting, post-operative treatment with Chinese medicine, post-operative with the affected limb free of weight-bearing walking for about 12 months, and continue to follow up for not less than 1 year after completely normal walking. 6.For pain (<6 months or so), collapse and collapse degree >4mm, the scope is large, age ≤40 years old, the use of incision joint with vascular bone flap transplantation, postoperative with Chinese medicine, rehabilitation treatment, the affected limb free of weight walking for about 12 months, completely normal walking after continuous follow-up for not less than 1 year; age >40 years old, the use of artificial joint replacement. 7.For those with longer pain (>9 months), but not serious degree, with collapse, joint mobility and good gait, use non-surgical treatment with Chinese medicine as well as rehabilitation; for those with serious pain, limited joint function and obvious limp, use artificial joint replacement. The above treatment methods are only general principles, but the actual clinical application still needs to be carefully designed for each specific patient, and at the same time fully communicate with the patient to obtain the maximum cooperation of the patient, in order to achieve the best therapeutic effect. It should be noted that the series of Chinese herbal medicines developed by our hospital for the treatment of osteonecrosis of the femoral head have been confirmed by numerous experiments and clinical studies to improve blood flow and promote necrosis repair, which are highly sought after by patients. Nowadays, many patients learn this information from different channels and ask for medication regardless of their specific conditions, as a result, some patients delay the best time for hip preservation treatment or waste time and money because their conditions have lost the value of hip preservation treatment. We would like to warn all patients that hip preservation treatment for femoral head necrosis, especially non-surgical hip preservation treatment, is very complicated and difficult, and requires a very professional doctor to provide the right help. It is not necessary to “talk about ‘replacement’ (artificial joint replacement)”. It is not right to “replace” a collapsed joint when you see it, but it is also not right to “save” the hip when it is already in an advanced stage of collapse. It is important to emphasize that all hip preservation treatments for femoral head necrosis have strict review requirements, generally every three months in the first two years of treatment, every six months in the third year, and every year after the fourth year. The total course of treatment is generally not less than one year.