This systematic review and meta-analysis included 11 randomized controlled trials with 642 patients (742 hips) suffering from femur head necrosis. It compared the outcomes of core decompression and bone grafting with and without the addition of PRP. Pooled outcomes of interest included the Harris hip score, visual analog scale, pain component of the Harris hip score, radiographic progression, treatment failure, good-to-excellent results, and adverse events. The analysis showed that adding PRP significantly improved function, reduced pain, delayed radiographic progression, decreased treatment failures, and increased the rate of good-to-excellent outcomes. The findings suggest that PRP enhances the effectiveness and safety of core decompression and bone grafting in treating femur head necrosis.