Summary: Biophysical techniques have been applied for the enhancement of bone repair in general and avascular necrosis (AVN) of the femoral head in particular. For AVN of the femoral head, electric and electromagnetic fields and acoustic waves have been used to promote bone formation and preserve the femoral head. The presence of a repair process within the femoral head and the potential to prevent resorption of subchondral trabeculae has provided the conceptual basis for using pharmacologic and biophysical techniques in the hopes of altering the balance of bone production and resorption in favor of maintaining bone mass and structure, preventing subchondral fracture, and preserving the hip. Electric stimulation has been used both invasively with core decompression and noninvasively with a capacitively coupled technique. Although some results were encouraging, minimal improvements in hip survival were demonstrated. Electromagnetic fields have also been used with and without core decompression. Some encouraging results in terms of pain relief, hip stability, and hip survival were demonstrated. Recently, acoustic shock wave therapy has been used with promising early results. Large scale, multicenter, prospective randomized studies are now needed to firmly establish one or another biophysical technique as effective therapies for AVN of the femoral head.