Porous Hydroxyapatite Bone Research Articles

Ionic substitution through bredigite doping for microstructure and performance adjustment in DLP 3D-printed TPMS porous HA bone scaffolds

ABSTRACT Hydroxyapatite (HA) is widely used in bone scaffold development, but still faces problems of forming difficulty, slow degradation, and limited biological performance. In this study, triply periodic minimal surface (TPMS) porous HA scaffolds were prepared using desktop-level DLP and then doped with bredigite (BR) to enhance their performance through ion substitution to adjust microstructure. The DLP-prepared scaffolds displayed intricate curved surface porous structure, and their micro-porosity decreased while grain size increased with sintering holding time. During sintering, Mg2+ from BR substituted Ca2+ in HA, forming new secondary phases, which slightly decreased grain size while significantly increased micro-porosity. These factors slightly reduced mechanical properties while significantly enhanced degradation. The rapid release of inorganic active ions from BR and new phases enhanced the biomineralization and cell response. This study demonstrated the potential of using desktop-level DLP to construct complex porous ceramic scaffolds and using ion substitution to modulate their microstructure and performance.

Experimental and numerical investigations for compressive behavior of porous hydroxyapatite bone scaffold fabricated via freeze-gel casting method

Artificial bone scaffolds with a porosity of ≥64% were manufactured using hydroxyapatite (HA). The Freeze-gel Casting method using tert-butyl alcohol (TBA) as a solvent was adopted to maintain proper mechanical strength. The manufactured HA scaffold had excellent internal connectivity owing to the continuous connection of the long columnar pores and arrangement of the constant pore walls. For the HA scaffold, compression tests at different strain rates under uniaxially compressed loads were performed, and the compressive behavior according to the strain rate was analyzed. A maximum yield stress of 2–3 MPa was observed, and the overall compressive behavior was divided into elastic, plateau, and densification sections, which were different from the brittleness behavior of ordinary ceramics and similar to that of polymer materials. The compressive behavior of the HA scaffold was successfully simulated by applying the Frank–Brockman–Zairi constitutive model used to simulate elasto-viscoplastic material behavior. Seven material parameters belonging to the constitutive equation were proposed for the HA scaffold by adopting a deterministic approach for material parameter identification. Models can be developed from methods for simulating the mechanical behavior of a porous ceramic scaffold to predict the long-term mechanical behavior of the scaffold inserted in vivo, which may help in bone defects recovery.

Additive manufacturing of graphene oxide/hydroxyapatite bioceramic scaffolds with reinforced osteoinductivity based on digital light processing technology

In the field of bone tissue engineering, porous hydroxyapatite (HA) bone repair scaffolds with controlled architecture and porosity are challenging to manufacture and lack sufficient osteoinductive activity, which limit its wider clinical application. This study fabricated porous graphene oxide (GO)/HA composite ceramic scaffolds using digital light processing (DLP) technology. The properties of the composite ceramic slurry and the process parameters of curing, degreasing, and sintering were initially examined to ensure molding accuracy. The research showed that a small amount of GO (0.1–0.4 wt%) could better maintain the pore structure and improve the mechanical properties of composite ceramics. Porous scaffolds with pore sizes of 300–400 μm were prepared for co-culture with rat bone marrow mesenchymal stem cells to detect biocompatibility. The results showed that all scaffolds have no cytotoxicity. Compared with HA, the GO/HA ceramic scaffold significantly promoted the cell adhesion, proliferation, and expression of osteogenesis-related genes; GO (0.1–0.2 wt%) /HA scaffolds exhibited superior alkaline phosphatase activity and more effective bone mineralization, showing enhanced osteoinductivity. The porous GO/HA composite scaffold fabricated by DLP presented a strong potential for repairing bone defects.

The Mechanosensory Role of Osteocytes and Implications for Bone Health and Disease States.

Bone homeostasis is a dynamic equilibrium between bone-forming osteoblasts and bone-resorbing osteoclasts. This process is primarily controlled by the most abundant and mechanosensitive bone cells, osteocytes, that reside individually, within chambers of porous hydroxyapatite bone matrix. Recent studies have unveiled additional functional roles for osteocytes in directly contributing to local matrix regulation as well as systemic roles through endocrine functions by communicating with distant organs such as the kidney. Osteocyte function is governed largely by both biochemical signaling and the mechanical stimuli exerted on bone. Mechanical stimulation is required to maintain bone health whilst aging and reduced level of loading are known to result in bone loss. To date, both in vivo and in vitro approaches have been established to answer important questions such as the effect of mechanical stimuli, the mechanosensors involved, and the mechanosensitive signaling pathways in osteocytes. However, our understanding of osteocyte mechanotransduction has been limited due to the technical challenges of working with these cells since they are individually embedded within the hard hydroxyapatite bone matrix. This review highlights the current knowledge of the osteocyte functional role in maintaining bone health and the key regulatory pathways of these mechanosensitive cells. Finally, we elaborate on the current therapeutic opportunities offered by existing treatments and the potential for targeting osteocyte-directed signaling.

Synthetic Bone Grafting in Aseptic Loosening of Acetabular Cup: Good Clinical and Radiological Outcomes in Contained Bone Defects at Medium-Term Follow Up.

Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required.

Characterization of Mechanical and Micro-Architectural Properties of Porous Hydroxyapatite Bone Scaffold Using Green MicroAlgae as Binder

Novel Hydroxyapatite (HA)-based porous bone scaffold is developed using green microalgae as binding as well as pore-forming agent. The composite scaffolds are developed at 1:2, 2:1 and 1:1 (w/w) compositions of HA and binder, respectively, using solvent-casting technique and their mechanical and micro-architectural properties are investigated. Material characterization of the scaffold shows improved mechanical strength with a maximum compressive strength of 2.89 MPa and maximum interconnected porosity of 65.29%. FT-IR and XRD results confirm formation of crystalline nano-HA in the scaffolds. SEM and TEM micrographs of the scaffolds show pore morphology with a maximum pore diameter of 258 microns and minimum pore diameter of 6 microns and uniformly dispersed rod-shaped nano-HA particles of length 3.95–99.11 nm, respectively. TG/DTG analysis shows high thermal stability of scaffolds with high HA content. Comparative study of the three types of scaffolds shows composites with equal weight ratio of HA, and binder yields the highest porosity and mechanical strength desired for cell growth and support. XRF analysis confirms Ca and P as the major constituent elements of the scaffold. The study highlights the potential of natural biomass as an alternative to synthetic and naturally derived polymeric binders for development of HA-based bone scaffolds.

Formation of osteon-like structures in unidirectional porous hydroxyapatite substitute.

Unidirectional porous hydroxyapatite (UDPHAp) bone substitute comprises a microstructure of cross‐sectionally oval pores with diameters ranging from 30 to 300 µm. Bone remodeling within the UDPHAp is expected upon implantation into bone; however, the mechanism and factors influencing this bone growth remain unclear. The objectives of the present study were to assess the vasculature and microstructure of newly formed bone and to determine how bone formation is affected by load transfer and UDPHAp pore size. Formation of osteon‐like structures, defined by the presence of lacunae, canaliculi and a central lumen containing capillaries, was observed within the implanted UDPHAp material in all animals after six weeks. The number of osteocytes and osteon‐like structures in areas adjacent to the cortex of recipient bone was significantly higher than in areas next to the medullary cavity throughout the recovery period. Notably, osteon‐like structures tended to form in smaller diameter pores. Continuous bone remodeling might be promoted by the rapid formation of unidirectional capillaries and the osteocyte lacunae‐canalicular system. Load transfer and smaller pore size could positively affect cortical bone regeneration. © 2018 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2665–2672, 2018.

A comparative evaluation of porous hydroxyapatite bone graft with and without platelet-rich plasma in the treatment of periodontal intrabony osseous defects: A clinico-Radiographic study

Background: Today, regenerative attempts for treatment of periodontal disease focus on the introduction of a filler material into the defect in hope of inducing bone regeneration. The purpose of this study was to clinically and radiographically evaluate the use of porous hydroxyapatite bone graft with and without platelet-rich plasma (PRP) in the treatment of intrabony defects. Materials and Methods: The study was carried out in ten patients between 18 and 60 years. Patients with pocket depth ≥5 mm and radiographic evidence of vertical bone loss in the affected site were randomly assigned to treatment with a combination of PRP + Hydroxyapatite (HA) (test sites) or HA alone (control sites). The parameters were compared at baseline and 6 months postoperatively. Results: There was a statistically significant reduction in probing depth and gain in clinical attachment in both the groups individually (more in experimental group); however, on comparing the two groups, the net reduction was not significant. Radiographic assessment showed a decrease in the defect size in both the groups. Conclusion: PRP in addition to a bone graft in the treatment of intrabony defects is safe and shows improved defect fill as compared to the use of bone graft alone.

Platelet-Rich Fibrin Combined With a Porous Hydroxyapatite Graft for the Treatment of 3-Wall Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial.

Porous hydroxyapatite (HA) bone grafting material has been used to fill periodontal intrabony defects (IBDs), resulting in clinically acceptable responses. Platelet-rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and, therefore, has the potential for use as regenerative treatment for periodontal defects. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF versus PRF + HA in treatment of IBDs in patients with chronic periodontitis. Ninety IBDs were treated with autologous PRF with open-flap debridement (OFD), PRF + HA with OFD, or OFD (controls) alone. Clinical and radiologic parameters, including probing depth (PD), clinical attachment level (CAL), IBD depth, and percentage defect fill were recorded at baseline and 9 months postoperatively. Mean PD reduction was greater in PRF (3.90 ± 1.09 mm) and PRF + HA (4.27 ± 0.98 mm) groups than the control group (2.97 ± 0.93 mm), and mean CAL gain was greater in PRF (3.03 ± 1.16 mm) and PRF + HA (3.67 ± 1.03 mm) compared to controls (2.67 ± 1.09 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (56.46% ± 9.26%) and PRF + HA (63.39% ± 16.52%) groups compared to controls (15.96% ± 13.91%). Treatment of IBD with PRF results in significant improvements of clinical parameters compared to baseline. When added to PRF, HA increases the regenerative effects observed with PRF in the treatment of 3-wall IBDs.

Effect of β-tricalcium phosphate and porous hydroxyapatite bone substitutes on bone regeneration in alveolar bone defects around dental implants

Effect of β-tricalcium phosphate and porous hydroxyapatite bone substitutes on bone regeneration in alveolar bone defects around dental implants

Rosuvastatin 1.2 mg In Situ Gel Combined With 1:1 Mixture of Autologous Platelet-Rich Fibrin and Porous Hydroxyapatite Bone Graft in Surgical Treatment of Mandibular Class II Furcation Defects: A Randomized Clinical Control Trial.

A wide range of regenerative materials have been tried and tested in the treatment of furcation defects. Rosuvastatin (RSV) is a new synthetic, second-generation, sulfur-containing, hydrophilic statin with potent anti-inflammatory and osseodifferentiation mechanisms of action. Platelet-rich fibrin (PRF) is a platelet concentrate having sustained release of various growth factors with regenerative potential to treat periodontal defects. Porous hydroxyapatite (HA) bone grafting material has a clinically satisfactory response when used to fill periodontal intrabony defects. This double-masked randomized study is designed to evaluate the potency of a combination of 1.2 mg RSV in situ gel with a 1:1 mixture of autologous PRF and HA bone graft in the surgical treatment of mandibular Class II furcation defects compared with autologous PRF and HA bone graft placed after open-flap debridement (OFD). One hundred five mandibular furcation defects were treated with OFD + placebo gel (group 1), PRF + HA with OFD (group 2), or 1.2 mg RSV gel + PRF + HA with OFD (group 3). Clinical and radiologic parameters (i.e., probing depth [PD], relative vertical and relative horizontal clinical attachment level [rvCAL and rhCAL], intrabony defect depth, and percentage of defect fill) were recorded at baseline and 9 months postoperatively. Mean PD reduction was greater in group 2 (3.68 ± 1.07 mm) and group 3 (4.62 ± 1.03 mm) than group 1 (2.11 ± 1.25 mm), and mean rvCAL and rhCAL gain were greater in group 2 (3.31 ± 0.52 and 2.97 ± 0.56 mm, respectively) and group 3 (4.17 ± 0.70 and 4.05 ± 0.76 mm) compared with group 1 (1.82 ± 0.78 and 1.62 ± 0.64 mm). A significantly greater percentage of mean bone fill was found in group 2 (54.69% ± 1.93%) and group 3 (61.94% ± 3.54%) compared with group 1 (10.09% ± 4.28%). Treatment of furcation defects with 1.2 mg RSV in situ gel combined with autologous PRF and porous HA bone graft results in significant improvements of clinical and radiographic parameters compared with OFD alone. These results imply that the combination of RSV, PRF, and HA has synergistic effects, explaining their role as a regenerative material in the treatment of furcation defects.

Comparative Evaluation of Bioactive Synthetic NovaBone Putty and Calcified Algae-derived Porous Hydroxyapatite Bone Grafts for the Treatment of Intrabony Defects.

IntroductionTo compare and evaluate clinically and radio-graphically the bone regeneration and the amount of bone fill in intrabony component of periodontal osseous defects through the osteoconductive and osteostimulative effect of bioactive synthetic NovaBone Putty - CMF and osteoconductive effect of calcified algae-derived porous hydroxyapatite Frios® Algi-pore® bone grafts.Materials and methodsTwenty-two sites in 11 patients, within the age range of 25 to 60 years, showing intrabony defects were selected according to split mouth design and divided into group I (Frios® Algipore®) and group II (NovaBone Putty - CMF). All the selected sites were assessed with the clinical and radiographic parameters like plaque index, gingival index (full mouth and site specific), sulcus bleeding index, probing pocket depth, clinical attachment level, gingival recession, and radiographic bone fill. All the clinical and radiographic parameter values obtained at different intervals (baseline, 3, and 6 months) were subjected to statistical analysis.ResultsA statistically significant reduction in pocket depth of 2.55 ± 0.52 mm (group I), 2.64 ± 0.67 mm (group II) and gain in clinical attachment level of 7.55 ± 1.44 mm (group I), 7.55 ± 2.38 mm (group II) were recorded at the end of the study. A slight increase in gingival recession was observed. The mean percentage change in amount of radiographic bone fill of group II (71.34%) was more than group I (61.93%).ConclusionBoth NovaBone Putty - CMF and Frios® Algipore® improve healing outcomes and lead to a reduction of probing depth, a resolution of osseous defects, and a gain in clinical attachment, but radiographic observation found better results with NovaBone Putty.How to cite this articleBembi NN, Bembi S, Mago J, Baweja GK, Baweja PS. Comparative Evaluation of Bioactive Synthetic NovaBone Putty and Calcified Algae-derived Porous Hydroxyapatite Bone Grafts for the Treatment of Intrabony Defects. Int J Clin Pediatr Dent 2016;9(4):285-290.

Bone Regeneration and Remodeling within a Unidirectional Porous Hydroxyapatite Bone Substitute at a Cortical Bone Defect Site: Histological Analysis at One and Two Years after Implantation.

Unidirectional porous hydroxyapatite (UDPHAp) is an artificial bone substitute with a unique microstructure consisting of 100–300-µm oval pores that present the material unidirectionally. UDPHAp has a compression strength of 14 MPa and a porosity of 75%, which promotes cell migration and capillary formation within the material. Despite these advantageous properties, bone remodeling and bone formation with UDPHAp remain unclear. To examine long-term remodeling and differences in bone formation based on the defect site, trapezoidal prism-shaped UDPHAp blocks were implanted into rectangular-shaped cortical bone defects in the proximal tibia of Japanese white rabbits. Histological analysis performed at 52 and 104 weeks after implantation revealed that bone and capillaries had formed within the implanted UDPHAp material. Bone formed within the UDPHAp implanted in the cortical defect of rabbit tibia and remodel up to two years. The percentage of new bone area within UDPHAp was larger in cortical lesions than that in medullary lesions. These findings suggest that UDPHAp is a promising material for the repair of non-critical-sized cortical bone defects.

Effect of nanocrystalline hydroxyapatite socket preservation on orthodontically induced inflammatory root resorption.

Orthodontically induced inflammatory root resorption (OIIRR) is considered to be an important sequel associated with orthodontic tooth movement (OTM). OTM after Socket preservation enhances the periodontal condition before orthodontic space closure. The purpose of this study is to investigate the histologic effects of NanoBone®, a new highly nonsintered porous nano-crystalline hydroxyapatite bone on root resorption following OTM. This experimental study was conducted on four male dogs. In each dog, four defects were created at the mesial aspects of the maxillary and mandibular first premolars. The defects were filled with NanoBone®. We used the NiTi closed coil for mesial movement of the first premolar tooth. When the experimental teeth moved approximately halfway into the defects, after two months, the animals were sacrificed and we harvested the area of interest. The first premolar root and adjacent tissues were histologically evaluated. The three-way ANOVA statistical test was used for comparison. The mean root resorption in the synthetic bone substitute group was 22.87 ± 11.25×10(-4)mm(2) in the maxilla and 21.41 ± 11.25×10(-4)mm(2) in the mandible. Statistically, there was no significant difference compared to the control group (p>0.05). The use of a substitution graft in the nano particle has some positive effects in accessing healthy periodontal tissue following orthodontic procedures without significant influence on root resorption (RR). Histological evaluation in the present study showed osteoblastic activity and remodeling environment of nanoparticles in NanoBone®.

Treatment of periodontal intrabony defects with platelet-rich fibrin and porous hydroxyapatite bone graft: A comparative clinical and radiographic study using Dentascan

Objective: The aim of the present study was to compare autologous platelet-rich fibrin (PRF) combined with a porous hydroxyapatite bone graft to porous hydroxyapatite bone graft alone in the treatment of periodontal intrabony defects clinically and radiographically using Dentascan. Materials and Methods: In a split-mouth study design, 10 patients suffering from generalized chronic periodontitis, having two almost identical intrabony defects with probing pocket depth of at least 5 mm were selected for the study and randomly divided into two groups. In Group I periodontal flap surgery followed by placement of porous hydroxyapatite bone graft was done and in Group II, periodontal flap surgery followed by placement of a homogenous mixture of PRF and porous hydroxyapatite bone graft was done. All the clinical parameters were recorded at baseline, 3 and 6 months postoperatively and radiographic parameters were recorded at baseline and 6 months postoperatively. Results: There was statistically significant reduction in probing pocket depth and gain in clinical attachment level in both groups. On comparison Group II showed statistically significant more probing pocket depth reduction than Group I at all-time intervals. There was statistically significant mean defect fill and mean defect resolution observed in both groups at all-time intervals. However, the intergroup comparison was statistically nonsignificant. Conclusion : Within limits of the study it may be concluded that a combination of PRF with porous hydroxyapatite bone graft demonstrated better results as compared to porous hydroxyapatite bone graft alone in the treatment of periodontal intrabony defects. Spiral multislice computed tomography equipped Dentascan provides three-dimensional images of excellent quality for evaluating the morphology of the periodontal bone defects. Its use in ascertaining the various defect parameters in the periodontal treatment of intrabony defects is promising.

Effect of â-tricalcium phosphate and porous hydroxyapatite bone substitutes on bone regeneration in alveolar bone defects around dental implants

When a sufficient bone mass or favorable bone quality is not available at the implant site, generally, fresh autologous bone transplantation is performed. However, to obtain autologous bone, surgical stress is inevitably applied to the healthy donor region, and the collectable amount of bone is limited. Thus, bone substitutes prepared with various materials have been investigated to substitute for autologous bone. Although artificial materials have no risk of infection compared to other body-derived materials, the clinical outcomes are poorer than those using other bone substitutes.

A clinical evaluation of a bioresorbable membrane and porous hydroxyapatite in the treatment of human molar class II furcations

Background:The ultimate goal of periodontal therapy is predictable regeneration of a functional attachment apparatus destroyed as a result of periodontitis. Reconstructive procedures have been used with varying success during the past decades to accomplish this goal.Aim:To evaluate whether the use of porous hydroxyapatite alone or a bioresorbable membrane alone would enhance the clinical results in the treatment of class II furcation defects in human lower molars.Materials and Methods:Fifteen patients with chronic periodontitis, aged between 39 and 49 years, with a pair of similar bilateral class II furcation defects (classification of Hamp et al.) in mandibular first molars were selected. A split-mouth design was incorporated and the selected 30 furcation defects were assigned to one of the two treatment groups, i.e., Group I treated with a bioresorbable membrane from bovine-derived collagen guided tissue regeneration membrane and Group II treated using porous hydroxyapatite bone graft material on the contralateral sides. Evaluation of clinical parameters, probing depths and attachment levels, and radiographs was done preoperatively and 6 months postoperatively.Results:Both the groups showed statistically significant mean reduction in probing depths and gain in clinical attachment levels and linear bone fill. Comparison between Group I and Group II showed insignificant difference.Conclusion:Within the limits of this study, both the treatment modalities are beneficial for the treatment of human mandibular class II furcation defects.

Clinical evaluation of porous hydroxyapatite bone graft (Periobone G) with and without collagen membrane (Periocol) in the treatment of bilateral grade II furcation defects in mandibular first permanent molars.

Background:Furcation invasions represent one of the most demanding therapeutic challenges in periodontics. This investigation assessed and compared the clinical efficacy of hydroxyapatite bone graft material when used alone and with collagen membrane in the treatment of grade II furcation defects.Materials and Methods:Ten patients with comparable bilateral furcation defects in relation to mandibular first molars were selected and treated in a split-mouth design. After the hygiene phase of therapy was completed, the groups were selected randomly either for treatment with hydroxyapatite bone graft (Periobone G) alone or with a combination of bone graft and guided tissue regeneration (GTR) membrane (Periocol). Clinical parameters like plaque index, gingival index, vertical probing depth, horizontal probing depth, clinical attachment level, position of marginal gingiva, and the amount of bone fill were used at baseline and at 3 and 6 months postoperatively.Results:At 6 months, both surgical procedures resulted in statistically significant reduction in vertical and horizontal probing depths and gain in the clinical attachment level.Conclusion:The use of combination technique yielded superior results compared to sites treated with bone graft alone. However, the difference was not statistically significant.

Radiological and Histological Evaluation of Regenos® which Implanted in Human Radial Fracture: A Clinical Case Report

Regenos® is a unidirectional porous hydroxyapatite (UDPHAp) bone substitutes, and the most distinctive feature of UDPHAp is its interconnected porous structure. We used Regenos® for the bone defect while distal radius fracture surgery with metal fixation implant. At six months post-operation, CT scans revealed the Regenos® implant was uniformly composed of cortical bone adjacent to the trabecular bone. At one-year postoperatively, we collected a sample of the implanted Regenos® while metal fixation plate removal surgery for histological evaluation. Regenos® implant sample revealed the presence of ossified bone stained green with Villanueva Goldner stain. Our findings demonstrate that Regenos® is a useful bone substitution material in the clinical setting.

Core decompression and implantation of bone marrow mononuclear cells with porous hydroxylapatite composite filler for the treatment of osteonecrosis of the femoral head

Implanted bone marrow mononuclear cells (BMMCs) may promote both osteogenesis and angiogenesis in the femoral head. The aim of this study was to investigate the effectiveness of core decompression and implantation of BMMCs with porous hydroxyapatite bone filler for the treatment of osteonecrosis of the femoral head (ONFH). Patients with ONFH underwent core decompression and implantation of nano-hydroxyapatite/polyamide bone filler with or without BMMCs. Primary outcomes were changes in Harris hip and visual analogue scale (VAS) pain scores. Secondary outcomes included radiological and clinical success rates, adverse events, and complications. Demographic/baseline characteristics were similar between groups (BMMC, n = 17 with 26 ONFH hips; control, n = 17 with 27 ONFH hips). Harris hip scores were significantly increased (P < 0.05) in both groups of patients after surgery (last follow-up). The magnitude of increase was significantly greater in the BMMC as compared with the control group (28.6 ± 0.5 vs. 18.4 ± 1.7 %, P < 0.001). VAS scores were significantly decreased (P < 0.05) in both groups after surgery (last follow-up). The magnitude of decrease was significantly greater in the BMMC as compared with the control group (-66.3 ± 1.4 vs. -51.7 ± 2.9 %, P < 0.001). Radiological and clinical success rates were significantly higher in the BMMC as compared with the control group (82.5 vs. 40.7 % and 75.4 vs. 37.0 %, respectively, P < 0.001). Postoperative collapse of the femoral head was less common in the BMMC as compared with the control group (17.5 vs. 59.3 %, P < 0.01). Both core decompression with or without implantation of BMMC are effective treatment for ONFH. However, core decompression with implantation of BMMCs and porous hydroxyapatite bone filler may be a more effective treatment for ONFH.