steonecrosis refers to the in situ death of bone, with the femoral head being the site most commonly affected. (AVN) of the femoral head is a common entity with approximately 20,000 new cases reported each year. AVN is the underlying diagnosis in as many as 10% of 500,000 total hip arthroplasties performed in the United States. A significant percentage of these hip arthroplasties are done in individuals in their late 30s and early 40s. To orthopaedic surgeons, however, early osteonecrosis of the femoral head often is silent or presents with nonspecific clinical finding, similarly early radiographic finding of the disease also may be inconspicious and as such, they may impose a challenge for clinicians and radiologists. The dilemma of this disease is that many surgeons and workers in its field find difficulties and confusion in selecting the appropriate approach to understand or to select the most acceptable methods or way regarding the aetiology, pathogenesis, classification and the most effective options of treatment. Here is this review articles we try to clarify or to nearly approximate the most widely acceptable methods of different treatment modalities. In addition to reviewing the pathology and some other related problems. The term avascular (AVN), osteonecrosis implies that a segment of bone has lost its blood supply so that the cellular elements die with it. The phrase “aseptic necrosis” indicates that infection generally plays no part in the process. Avascular necrosis has long appears as a distinctive feature in a number of nontraumatic disorders. Sites which are peculiarly vulnerable to ischemic necrosis are the femoral head, the femoral condyles, the head of humerus, the capitulum, proximal part of the scuphiod, talus, patella and the vertebra. The anatomic coarse and the nature of the blood vessels, with the characteristic histological structures of the blood vessels in this area probably give a good Correspondence to: Dr. Mohammed H. Kubba Department of Orthopaedic Surgery, Basrah General Hospital, Basrah; IRAQ. O Leading Article