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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\u2009+\u2009SBG. This study included 931 hips with Stages I or II of ONFH\u2014414 treated with CD, 379 treated with CD\u2009+\u2009SBG, and 138 treated with CD\u2009+\u2009SBG with adjuvant therapies (CD\u2009+\u2009SBG\u2009+\u2009ADJ). The radiographic progression was 37% for CD, 33% for CD\u2009+\u2009SBG, and 32% for CD\u2009+\u2009SBG\u2009+\u2009ADJ, with no differences between subgroups (P\u00a0=\u2009.922). The mean total hip arthroplasty conversion rate was 31% for CD, 17% for CD\u2009+\u2009SBG, and 15% for CD\u2009+\u2009SBG\u2009+\u2009ADJ, with no differences between subgroups (P\u00a0=\u2009.08). The complication rates were 0.9% for CD and 2.8% for CD\u2009+\u2009SBG and CD\u2009+\u2009SBG\u2009+\u2009ADJ groups combined. There is no clear evidence that SBGs improve outcomes over CD alone.<\/jats:p>","DOI":"10.1093\/jhps\/hnaf035","type":"journal-article","created":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T07:46:07Z","timestamp":1749282367000},"page":"74-87","source":"Crossref","is-referenced-by-count":2,"title":["Evidence for using synthetic bone grafts for the treatment of osteonecrosis of the femoral head: a systematic review of the literature and meta-analysis"],"prefix":"10.1093","volume":"13","author":[{"given":"Micha\u0142","family":"D\u0119bi\u0144ski","sequence":"first","affiliation":[{"name":"Departments of Trauma and Orthopaedic Surgery and Rehabilitation, Mazovian Br\u00f3dnowski Hospital , Kondratowicza 8, 03-242 Warsaw, mazowieckie ,","place":["Poland"]},{"name":"Department of Trauma and Orthopaedic Surgery, The Dr. Jozef Psarski Masovian Specialist Hospital in Ostroleka , Aleja Jana Paw\u0142a II 120A, 07-410, Ostro\u0142\u0119ka, mazowieckie ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart B","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University , 450 Broadway Street, Redwood City, California 94063 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerzy","family":"Walecki","sequence":"additional","affiliation":[{"name":"Department of Radiology, Centre of Postgraduate Medical Education , Marymoncka 99\/103, 01-813 Warsaw, mazowieckie ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstancja","family":"Bobecka-Weso\u0142owska","sequence":"additional","affiliation":[{"name":"Faculty of Mathematics and Information Science, Warsaw University of Technology , Koszykowa 75, 00-662 Warsaw, mazowieckie ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5475-1999","authenticated-orcid":false,"given":"Marcin K","family":"Wa\u015bko","sequence":"additional","affiliation":[{"name":"Department of Radiology, Centre of Postgraduate Medical Education , Marymoncka 99\/103, 01-813 Warsaw, mazowieckie ,","place":["Poland"]},{"name":"Health Sciences Department, Ignacy Mo\u015bcicki University of Applied Sciences in Ciechan\u00f3w , Wojska Polskiego 51, 06-400 Ciechan\u00f3w, mazowieckie ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"2026052203213935100_ref1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.ejrad.2007.03.019","article-title":"Osteonecrosis of the femoral head: etiology, imaging and treatment","volume":"63","author":"Malizos","year":"2007","journal-title":"Eur J Radiol"},{"key":"2026052203213935100_ref2","doi-asserted-by":"publisher","first-page":"250","DOI":"10.5435\/00124635-199907000-00005","article-title":"Osteonecrosis of the femoral head","volume":"7","author":"Lavernia","year":"1999","journal-title":"J Am Acad Orthop Surg"},{"key":"2026052203213935100_ref3","doi-asserted-by":"publisher","first-page":"2342","DOI":"10.1016\/j.arth.2020.04.092","article-title":"Diagnosis of osteonecrosis of the femoral head: too little, too late, and independent of etiology","volume":"35","author":"Boontanapibul","year":"2020","journal-title":"J Arthroplast"},{"key":"2026052203213935100_ref4","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.2106\/JBJS.19.01271","article-title":"Nontraumatic osteonecrosis of the femoral head: where do we stand today? 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