Bone Marrow-Derived Cell Therapy Plus Core Decompression Enhanced Efficacy Compared With Core Decompression Alone in Treating Osteonecrosis of the Femoral Head: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

PURPOSE: To systematically determine whether bone marrow-derived cell therapy combined with core decompression could result in better improvements in pain relief, function, and radiographic progression, higher survival of hip joints, and an equivalent rate of adverse events than hip-preserving techniques alone in individuals with osteonecrosis of the femoral head (ONFH). METHODS: We searched randomized controlled trials of core decompression with or without cell-based therapy in osteonecrosis of the femoral head across MEDLINE, the Cochrane Central Register of Controlled Clinical Trials, PubMed, Embase, Web of Science, and the Physiotherapy Evidence Database from inception to April 2025. Standardized mean difference (SMD) and risk ratio (RR) with 95% confidence intervals (CIs) of outcomes were reported. The pooled data with sensitivity analysis and subgroup analysis were conducted via RevMan 5.4. RESULTS: Ten studies with 460 participants (530 hips) were included. The results revealed that cell therapy plus core decompression improved pain relief (SMD: -1.30; 95% CI: -2.21 to -0.38), hip function (SMD: -1.79; 95% CI: -1.79 to -0.90), and survival of hip joints (RR: 0.47; 95% CI: 0.27-0.82) better than core decompression alone. No differences in radiographic progression (RR: 0.34; 95% CI: 0.08-1.47; SMD: -1.02; 95% CI: -2.70 to 0.65) or adverse events (RR: 2.13; 95% CI: 0.29-15.42) were observed between groups. CONCLUSIONS: The combination of bone marrow-derived cell therapy with core decompression may be better for pain relief, function, and survival of joints for osteonecrosis of the femoral head than core decompression alone but remains limited and heterogeneous. Additionally, there was no difference in adverse events and radiographic progression between groups. LEVEL OF EVIDENCE: Level I, meta-analyses of randomized controlled trials.