What conditions of femoral head necrosis can be considered for conservative treatment first? Conservative treatment includes two aspects: one is conservative treatment without surgery, and the other is conservative treatment with surgery, that is, surgery to preserve the femoral head. If the treatment is purely pharmacological, it is generally suitable for relatively mild cases, where only some symptoms are present and no obvious lesions can be seen on X-ray, or only some very slight bone changes can be seen. In this case, some Chinese herbal medicine, rest, weight reduction, stop drinking alcohol, etc., may be useful. If at the second stage, the imaging looks like some early bone changes, but the shape of the femoral head is still relatively good, and the joint space is also relatively good, it is not suitable for artificial joint replacement at this time, and surgery to preserve the femoral head can be considered. There are actually several ways to preserve the femoral head, one of which is the so-called drilling and decompression. Why is this surgery available? Some people have researched this procedure and believe that femoral head necrosis may be caused by increased pressure in the femoral head, which may affect the venous return, and that drilling a few holes will release the pressure, which may facilitate the recovery of femoral head necrosis. The other type of surgery involves drilling larger holes, often to the lesion, then cleaning out the diseased tissue and taking some fresh bone from the patient’s body to fill in (also known as bone grafting) so that it can re-form a bone structure. However, instead of bone grafting, some doctors put a flexible device into the femoral head to increase the support inside the femoral head. In addition to this, some doctors will take another approach, which is to take an autologous fibula or allogeneic fibula graft to the femoral head to strengthen the support of the femoral head. Of course, some patients do not want to take their own fibula, after all, it is a bit like tearing down the east wall to make up the west wall, so a special metal, called bone trabecular metal, can be put inside the femoral head for support. In fact, all of the above methods have one purpose – to increase the support of the femoral head, while allowing the bone inside it to rebuild and get repaired. However, although there are many of these approaches and they have been reported in the literature, to date, none of them have been very effective. So, when a patient asks, “If you treat with this method, will I be able to get out of having an artificial joint replacement?” Probably no one can answer that question, just because the results of these approaches are currently not exact. Because of this, sometimes we are faced with the difficult choice of whether it’s better for the patient to have femoral head preservation surgery or to do nothing at all and just have an artificial joint replacement when it’s too late. To be honest, this is also a choice. What medications are usually taken for conservative treatment? Do calcium, active vitamin D, bisphosphonates, and some Chinese medicines that invigorate blood circulation work for femoral head necrosis? At this point in time, no drug has a very definite and highly efficacious effect on osteonecrosis of the femoral head, at least I have not seen any evidence-based medical data on this. Drugs that are theoretically beneficial for bone growth may be helpful, so you can try them in the early stages, when surgery is not yet appropriate. However, when using drugs, it is important to use them appropriately according to the indications/contraindications and instructions for their use. Is it absolutely impossible to bear weight during the conservative treatment of femoral head necrosis? Generally speaking, unnecessary weight bearing should be minimized. However, there is no clear limit to how much weight should be put on the femoral head, as each patient has a different lesion, age and physical condition. How to put weight on, how to rest, and how to move should depend on the patient’s specific situation, and the attending physician should give specific plans and requirements, but strenuous activities such as running and jumping are not suitable. Non-weight-bearing exercises such as swimming and cycling can be considered; in addition, weight gain is definitely not good, and patients should also try to reduce prolonged walking or standing to avoid prolonged weight-bearing on the femoral head. How should patients observe changes in their condition during conservative treatment and how often should they be examined? Regardless of whether surgery is done or not, it is important to review the progress of the femoral head lesion on a regular basis. At the beginning, a film can usually be taken once every three months, then about once every six months, and when the lesion has become more stable, a film can be taken once a year. The purpose of the review is to see the progress of the lesion. If it remains unchanged or even slowly improves, then the current treatment can be continued; if the lesion becomes more severe, or even more obvious osteoporosis appears, then surgery may need to be considered.