30 patients with bilateral osteonecrosis of the femoral head scheduled for core decompression with stem cell injection had one hip allocated to computer-assisted navigation and one hip allocated to traditional fluoroscopic guidance. Outcome measures included precision of trocar placement, including relative to the subchondral bone of the femoral head and to the center of the osteonecrotic zone, radiation time, and rate of collapse and total hip arthroplasty over a 6-year follow-up. Results demonstrated a significantly better precision of trocar placement in the CAS group compared to the fluoroscopy group, as well as a significantly shorter radiation time. Additionally, the rate of head collapse and the need for total hip arthroplasty over the follow-up was significantly lower in the CAS group compared to the fluoroscopy group