47 randomized controlled trials (3,266 patients) assessed the efficacy and safety of traditional Chinese medicine (TCM) combined with Western medicine in treating osteonecrosis of the femoral head (ONFH). Patients received either TCM combined with Western medicine, physiotherapy, or hip preservation, compared to those treatments alone. The primary outcome of interest was the Harris Hip Score (HHS), while secondary outcomes included pain on a Visual Analog Scale (VAS), imaging improvement, and the incidence of adverse events. The meta-analysis demonstrated that TCM combined with Western medicine significantly improved HHSm reduced VAS pain scores, and enhanced imaging outcomes without increasing adverse events, suggesting this combination is an effective and safe approach for ONFH treatment.