Clinical Outcomes of Regenerative Orthobiologic Treatments in Hip Avascular Necrosis: A Systematic Review and Meta-Analysis

Hip avascular necrosis is an unstable disease that mostly affects younger patients and is likely to cause collapse of the femoral head, eventually resulting in total hip arthroplasty in spite of efforts put into hip-preservation therapy. The use of regenerative orthobiologic therapies, such as bone marrow-derived cell therapies and platelet-rich plasma, is becoming more popular as it may improve biological repair and retard disease progression. This review evaluated the clinical outcomes of regenerative orthobiologic treatments in hip avascular necrosis, with a focus on conversion to total hip arthroplasty. A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, Scopus, and the Virtual Health Library were searched from inception to December 2025. Comparative studies involving adult patients treated with regenerative orthobiologics were included. The primary outcome was conversion to total hip arthroplasty, which was evaluated with the help of a random-effects model with risk ratios and 95% confidence intervals. Thirteen studies were included. The primary analysis of cell-based therapies demonstrated a significant reduction in total hip arthroplasty conversion (RR 0.53, 95% CI 0.32-0.86) with moderate heterogeneity (I2 = 66.5%). The secondary analysis of other regenerative interventions also showed a significant reduction (RR 0.43, 95% CI 0.22-0.85) and had no heterogeneity (I2 = 0.0%). Regenerative orthobiologic treatments were associated with improved hip preservation and may delay progression to total hip arthroplasty, particularly in early-stage disease.