[Systematic review and Meta-analysis of core decompression combined with bone marrow transplantation versus core decompression alone in the treatment of osteonecrosis of the femoral head].

Abstract

Objective: To compare clinical efficacy and safety of core decompression combined with bone marrow transplantation versus core decompression alone in the treatment of osteonecrosis of the femoral head (ONFH) through systematic evaluation and meta-analysis.

Methods: In accordance with the preferred reporting items for systematic reviews and Meta-analyses (PRISMA) principles, a search was conducted in PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), VIP Database, Wanfang Database, and Chinese Biomedical Literature Database for clinical randomized controlled trial (RCT) and non-randomized controlled trial (nRCT) related to core decompression combined with bone marrow transplantation and simple core decompression for ONFH published from January 2000 to September 2025. After literature screening, data extraction and quality evaluation, Review Manager 5.4 and R 4.4.2 software were used to compare visual analogue scale (VAS) for hip joint pain, Harris score for hip joint, the progression of the disease on imaging, the rate of total hip replacement, and the incidence of adverse reactions.

Results: A total of 15 relevant studies were finally included, consisting of 14 RCTs and 1 nRCT, involving 607 patients and 693 hip lesions. Among them, 369 hips were in core decompression combined with bone marrow transplantation group, and 324 hips were in simple core decompression group. Meta-analysis result showed there were statistically significant differences between two groups in terms of Harris score for hip joint[6 months after operation, MD=4.57, 95%CI(2.62, 6.53), P<0.000 01;12 months after operation, MD=8.18, 95%CI(6.81, 9.55), P<0.000 01;24 months after operation, MD=11.63, 95%CI(10.40, 12.86), P<0.000 01], imaging disease progression[OR=0.24, 95%CI(0.15, 0.41), P<0.000 01], and total hip replacement rate [OR=0.28, 95%CI(0.13, 0.64), P=0.003]. The comparisons of VAS[MD=-0.43, 95%CI(-1.58, 0.71), P=0.46] and the incidence of adverse reactions[OR=2.48, 95%CI(0.83, 7.42), P=0.10] showed no statistically significant differences.

Conclusion: The safety of core decompression combined with bone marrow transplantation in the treatment of ONFH is comparable to that of simple core decompression. Moreover, it has more advantages in improving hip joint function, delaying disease progression, and reducing the need for total hip replacement in the end stage. This provides a better option for the hip preservation treatment of early ONFH.