Purpose <p>Osteonecrosis of the femoral head (ONFH) is a debilitating condition caused by disrupted blood supply, leading to bone tissue death, pain, and reduced mobility. The purpose of this review is to consolidate current knowledge of ONFH, focusing on treatment options and highlighting the potential of innovative therapies to optimize management and delay disease progression.</p> Methods <p>The authors performed a review of the current literature examining the clinical presentation, diagnostic imaging techniques, and both non-surgical and surgical treatment approaches for ONFH. The literature was summarized in a narrative review using sources from PubMed, SCOPUS, and Google Scholar, with a focus on studies providing current and emerging evidence relevant to clinical decision-making and therapeutic innovation.</p> Results <p>ONFH diagnosis relies on a combination of clinical evaluation and imaging modalities such as radiographs (XRs) and magnetic resonance imaging. Early-stage ONFH can be managed with non-surgical options like biophysical stimulation and pharmacologic therapies to preserve joint function. Advanced cases often require surgical interventions, including core decompression, osteotomies, and autologous bone grafting, which restore the joint surface and delay progression to total hip arthroplasty. Emerging treatments, such as bone marrow aspirate concentrate, platelet-rich plasma, and osteochondral allograft, have shown promise in enhancing surgical outcomes and improving bone regeneration.</p> Conclusions <p>ONFH management requires a multidisciplinary approach tailored to disease stage and patient-specific factors. While early interventions focus on preserving joint integrity, advanced stages benefit from surgical techniques and innovative therapies. This review aims to improve the understanding of ONFH and facilitate accurate diagnosis and appropriate management, ultimately improving patient outcomes.</p>