Evidence for using synthetic bone grafts for the treatment of osteonecrosis of the femoral head: a systematic review of the literature and meta-analysis

Synthetic bone grafts (SBGs) potentially add structural stability after core decompression (CD) for osteonecrosis of the femoral head (ONFH). This systematic review assessed the evidence supporting the (i) radiographic efficacy, (ii) revision rates, and (iii) safety of CD and CD with SBG for the treatment of ONFH. A total of 6549 papers were screened. Inclusion criteria were met by 12 studies for CD and by 14 studies for CD + SBG. This study included 931 hips with Stages I or II of ONFH—414 treated with CD, 379 treated with CD + SBG, and 138 treated with CD + SBG with adjuvant therapies (CD + SBG + ADJ). The radiographic progression was 37% for CD, 33% for CD + SBG, and 32% for CD + SBG + ADJ, with no differences between subgroups (P = .922). The mean total hip arthroplasty conversion rate was 31% for CD, 17% for CD + SBG, and 15% for CD + SBG + ADJ, with no differences between subgroups (P = .08). The complication rates were 0.9% for CD and 2.8% for CD + SBG and CD + SBG + ADJ groups combined. There is no clear evidence that SBGs improve outcomes over CD alone.