Osteonecrosis of the femoral head leads to degeneration of the head and finally to osteoarthritis of the hip. Decompression is the most widely used treatment, but its effectiveness is limited. It has been proposed instillation of stem cells in addition to decompression, would lead to better results. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including two randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded instillation of bone marrow stem cells at the time of core decompression probably slows progression to osteoarthritis of the hip in patients with osteonecrosis of the femoral head and might reduce the need of subsequent surgeries. It is unclear whether it has any effect on the functionality because the certainty of the evidence is very low.
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