Clinical Guideline for Non-Surgical Treatment of Osteonecrosis of the Femoral Head (2025 Edition)

Background: Osteonecrosis of the femoral head (ONFH) is a prevalent and refractory condition in orthopedic clinical practice. In recent years, an increasing number of patients have been diagnosed in the early stages of the disease. Consequently, traditional surgical interventions alone can no longer satisfy current clinical needs, highlighting the urgent demand for effective non-surgical management strategies. Objective: This guideline aims to provide a standardized framework for the non-surgical treatment of ONFH. It focuses on how to rationally and effectively apply these methods to delay disease progression, improve hip joint function, postpone or even avoid surgery, and ultimately achieve the goal of hip preservation. Methods: This guideline systematically evaluates and synthesizes evidence on the application of various non-surgical treatment modalities in the prevention and management of ONFH. These modalities include general therapy, pharmacotherapy, physical therapy, traditional Chinese medicine, minimally invasive interventions, and rehabilitation. Conclusion: The rational and evidence-based application of non-surgical treatments is of great significance for patients with early-stage ONFH. By following this guideline, clinicians can develop individualized, comprehensive non-surgical regimens that effectively control risk factors, alleviate symptoms, retard the collapse of the femoral head, preserve native hip function, and improve patients' quality of life, thereby reducing the long- need for hip arthroplasty.