Fifty-nine patients were randomized into receiving bone marrow aspirate concentrate (BMAC) or osteoblastic cell therapy for the treatment of nontraumatic osteonecrosis of the femoral head (ONFH). The primary outcomes included fracture progression as well as improvement in pain and functionality, which were all measured at 36 months. The secondary outcomes consisted of the proportion of hips converted to THA, which was assessed at 36 months. Moreover, incidence of adverse events were also measured. No significant or clinical differences were observed between the two treatment arms for either the primary or secondary outcomes, with the exception of the improvement from baseline in pain scores, which was statistically but not clinically significantly different between groups. Therefore, this study demonstrates that osteoblastic cell therapy does not provide additional clinical advantages compared to BMAC treatment; however, the small sample size and lack of long-term outcomes are limitations which will require futures studies.