Hua K, Yang X, Feng J, et al. - Thirty-two studies involving 1,865 patients (2,441 hips) were included to inspect the safety and efficiency of core decompression in the treatment of osteonecrosis of the femoral head (ONFH, is interrupted or damaged by the blood supply to the femoral head, resulting in death and subsequent repair of bone cells and bone marrow components, which in turn results in structural alterations in the femoral head and collapse of the femoral head, producing joint pain and dysfunction in patients, and the disease is challenging to heal). Results revealed that the overall success rate was 65%. The rate of success exhibited a meaningful variation on the outcomes of various stages. The rate of success, conversion to THA, and radiographic progression revealed a notable variation on the outcomes of ONFH using various treatments. Core decompression was an efficient and safe method of treating ONFH. The combined use of autologous bone or bone marrow could enhance the success rate. The use of core decompression should be careful, for advanced femoral head necrosis. High-quality randomized controlled trials and prospective studies would be needed to elucidate the impacts of various etiology factors, treatments, and postoperative rehabilitation. Until then, the surgeon may select core decompression to treat ONFH depending on the patient’s condition.