TABLE III.

Recommendation for Treatment of Osteonecrosis of the Femoral Head

Treatment	Grade of Recommendation*
Operative
Precollapse
Core decompression	A
Multiple small-diameter drilling	A
Adjunctive bone-grafting	A
Cell-based therapy	B
Nonvascularized bone-grafting	B
Vascularized bone-grafting	B
Tantalum rod	C
Rotational osteotomy	B
Angular osteotomy	C
Postcollapse
Total hip arthroplasty	A
Nonoperative
Observation	I
Weight-bearing restriction	I
Bisphosphonates	I
Anticoagulants	I
Vasodilators	I
Acetylsalicylic acid	I
Extracorporeal shockwave therapy	I
Pulsed electromagnetic fields	I
Hyperbaric oxygen	I

^*According to Wright¹⁸⁸, grade A indicates good evidence (Level-I studies with consistent findings) for or against recommending intervention; grade B, fair evidence (Level-II or III studies with consistent findings) for or against recommending intervention; grade C, poor-quality evidence (Level-IV or V studies with consistent findings) for or against recommending intervention; and grade I, insufficient or conflicting evidence not allowing a recommendation for or against intervention.