Thirty-eight patients (50 hips) with early-stage osteonecrosis of the femoral head were randomized to receive autologous bone marrow derived mesenchymal stem cells (BM-MSCs) combined with core decompression (n=18, 26 hips) or core decompression alone (n=20, 24 hips). The outcomes of interest included pain reduction, measured by the Visual Analog Scale (VAS), the Harris Hip Score (HHS), and the modified Kerboul angle for quantification of necrotic area via MRI. Outcomes were assessed at a mean follow-up of 8.8 months, ranging from 4 to 14 months. Overall, the results of the study revealed that the combined treatment significantly improved VAS scores (p=0.017), HHS (p=0.00), and modified Kerboul angle compared to core decompression alone. The findings suggest that autologous bone marrow derived mesenchymal stem cells enhance clinical outcomes in early-stage osteonecrosis of the femoral head.