Core decompression combined with bone marrow mononuclear cells in the treatment of femoral head necrosis: a systematic review and meta-analysis

Background: The effectiveness of bone marrow mononuclear cells (BMMCs) combined with core decompression (CD) in the treatment of femoral head necrosis is controversial. The purpose of this study was to conduct a meta-analysis and systematic review of the evaluation of BMMCss combined with CD in the treatment of femoral head necrosis and to compare the therapeutic effect of this method with that of CD alone so as to provide a basis for subsequent research and clinical treatment. Methods: We conducted detailed searches across four databases in Embase, PubMed, Web of Science, and the Cochrane Library (up to October 2023), including eight studies with a total of 370 participants and 491 hip cases. This meta-analysis followed the Preferred Reporting Project (PRISMA) guidelines. Review Manager 5.4 was used to summarize and analyze the outcome indicators and the quality and reliability of the MAs were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Results: Eight studies were included in the inclusion criteria. The results of meta-analysis showed that the therapeutic effect of CD combined with BMMC on visual analog scale was better than that of CD alone [mean difference (MD)=−5.32, 95% confidence interval (CI): −9.90, −0.74, P =0.02, I 2 =98%], and there was no statistically significant difference between CD combined with BMMC and CD alone in the treatment of Harris hip score (MD=2.73, 95% CI: −2.63, 8.09, P =0.32, I 2 =82%). We conducted a sensitivity analysis. The results showed that the CD joint BMMC treatment effect on the Harris hip score is superior to the single CD (MD=5.57, 95% CI: 1.94, 9.20, P =0.003, I 2 =0%), both no significant differences in visual analog scale (MD=0.47, 95% CI: −1.74, 0.79, P =0.46, I 2 =83%). Conclusion: In this study, we found that CD combined with bone marrow monocyte therapy improved femoral head necrosis better than CD alone.