To retrospectively analyze the clinical failure effect of core decompression with implantation of autologous bone marrow mononuclear cells for the treatment of osteonecrosis of the femoral head(ONFH).

In total, 38 patients (50 hips) underwent core decompression and implantation of autologous bone marrow mononuclear cells for treatment of ONFH during the period from July 2011 to September 2012. There were 28 male and 10 female cases, with an average age of 31.9. Three patients (5 hips) lost follow up. The patients were classified by their Association Research Circulation Osseous(ARCO) staging and China-Japan Friendship Hospital (CJFH) typing system. The clinical evaluation was conducted by pre-and post-operative Harris hip scores (HHS). The data were analyzed by Pearson test.

Hip replacement surgery was performed for 19 hips; 3 hips Harris score of less than 70 but did not undergo total hip arthroplasty. Surgical failure rates for patients belonging to ARCO stage Ⅱ, ⅢA and ⅢB were 22.2%、62.5%、100%, value 10.03, likelihood ratio 11.54, linear-by-linear association 9.81. The failure rates of L2, L3 and (C+ L1) type were 66.7%, 76.0%, 5.9%, value 20.32, likelihood ratio 23.38, linear-by-linear association 19.14. There were significant differences between different stages and types(with P values were 0.00).

Stage and type are risk factors of this surgery. Patients belonging to ARCO Ⅲ and those with necrotic lesions involving the lateral pillar (L2 and L3 type) showed high surgical failure rates. The best indications of this procedure are for ARCO stage Ⅱ and CJFH L1 and C type.