Size and location of the lesion, subchondral collapse occurrence, and articular cartilage involvement are general
disease progression criteria for direct
osteonecrosis of the femoral head (ONFH) classifications. Treatment options for ONFH are usually based on individual factors and lesion characteristics. Although spontaneous repair of ONFH occurs in some cases, untreated ONFH is unlikely to escape the fate of subchondral collapse and usually ends up with
total hip arthroplasty. Operations to preserve the femoral head, e.g., core
decompression and
bone grafting, are usually recommended in younger patients. They are helpful to relieve
pain and improve function in the affected femoral head without subchondral collapse, however, poor prognosis after
surgical procedures remains the major problem for ONFH. Pharmacological and
physical therapies only work in the early stage of ONFH and have also been recommended as a supplement or prevention treatment for
osteonecrosis. Following advances in basic science, many new insights focus on bone tissue engineering to optimize
therapies and facilitate prognosis of ONFH. In this review, disease classifications, current treatment options, potential
therapies, and the relevant translational barriers are reviewed in the context of clinical application and preclinical exploration, which would provide guidance for preferable treatment options and translation into novel
therapies.