72 patients with osteonecrosis of the femoral head were randomized to receive 5 sessions of extracorporeal shockwave therapy guided by MRI-3D reconstruction (n=36) or 9 days of celecoxib with sham shockwave therapy (n=36). All patients received alendronate in addition to study interventions. The primary outcome of interest was treatment efficacy after the 2nd week of treatment (Harris Hip Score [HHS] score improvement of at least 10 points). Secondary outcomes of interest included HHS scores, Visual Analog Scale (VAS) pain scores, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Outcomes were assessed up to 8 weeks follow-up. Treatment efficacy was non-inferior between the two groups, with a higher rate in the shockwave group. VAS scores were significantly better in the shockwave group up to 2 weeks follow-up, and up to 4 weeks follow-up for HHS scores.