Fourteen randomized controlled trials involving 909 patients with osteonecrosis of the femoral head (ONFH) were included in this systematic review and meta-analysis comparing platelet-rich plasma (PRP) therapy with non-PRP interventions. Pooled outcomes included Harris Hip Scores (HHS), Visual Analog Scale (VAS) scores for pain, femoral head collapse rates, rates of conversion to total hip arthroplasty, and overall complications. The meta-analysis showed that PRP therapy improved HHS and reduced VAS scores, with lower collapse and arthroplasty rates. However, these differences often did not reach clinically meaningful thresholds, and evidence quality was low. These findings suggest PRP may provide modest benefits in managing ONFH, warranting further high-quality studies.