Introduction: Hip joint necrosis is the most commonly affected joint with avascular necrosis. Other common ischemic necrosis includes carpal bones, talus, metatarsal bones, mandible bone, and humeral head. It is important for the orthopedic surgeon to understand the underlying mechanisms and extent of severity to determine the best approach to management. Methodology: PubMed database was used for article selection, papers on were obtained and reviewed. PubMed database was used for article selection, and the following keys terms: avascular necrosis, femoral head necrosis, ischemic necrosis management. Review: Patients with avascular necrosis present with joint pain of varying degrees. This pain is often associated with an underlying bone framework collapse. Peri-operative classification systems such as Ficat-Arlet criteria are used for staging femoral head necrosis, and proves useful in imaging and operative approach to treatment. Conclusion: The orthopedic surgeon should rely on his/her clinical judgment on per case basis, combining this with high-resolution imaging of radiographs and magnetic resonance. Staging is helpful in determining the best approaches to management.