Hip-preserving surgery has been variable in treating osteonecrosis of the femoral head (ONFH), but there is a lack of consensus on the effectiveness of joint preserving procedures for ONFH. It is undesirable that hip replacement has been undertaken for the young individuals in whom hip prostheses have a limited survival. It is better to preserve the femoral head than replace it [
1]. The exact mechanisms of femoral head collapse remain unclear. One hypothesis is based on the effects of shear stress at the boundary of necrotic and normal zones [
2], and the other is in accordance with the grade of bone resorption at the boundary [
3]. Karasuyama et al. [
4] indicated that sclerotic differences at the boundary may play a crucial role in the pathomechanism of femoral head collapse. Core decompression with or without bone grafting are the most common technique for the early stages of ONFH [
5‐
8]. Nevertheless, the current clinical results were not very satisfactory for patients in the early stages of ONFH performed with core decompression due to the lack of the sufficient structural support [
9‐
11]. Various osteotomies including transtrochanteric rotational osteotomy and curved varus osteotomy have been presented well-known to treat ONFH [
12]. Nevertheless, some studies have described various clinical results and risk factors for failure of the osteotomies, such as nonunion of the osteotomy and postoperative fracture of the femoral neck [
13]. Porous tantalum implant procedure has been used for the management of the early stages of ONFH [
14]. However, this procedure is neither entirely effective nor can it obtain predictable results [
15‐
17]. It has been demonstrated that the implantation of a non-vascularized or vascularized fibula graft is a valuable treatment option for femoral head collapse prevention and hip function improvement in patients with pre-collapse osteonecrosis [
18‐
21]. However, this technique may have certain drawbacks in that the implanted bone flaps would result in potential postoperative displacement. Improper post-operative weight-bearing onto the operated hip can also lead to the loosening of the implanted bone flaps, as well as poor bone regeneration and fusion [
19,
22,
23].
In the actual practice, an ideal implant should be guaranteed to contact with the bone around the tunnel of the core decompression, as well as buttressing the subchondral bone of the femoral head. Collapse of femoral head will be less likely to occur when the implant contacted with the subchondral bone maximally [
24]. Therefore, based on this principle, researchers have designed numerous devices for mechanical support of the femoral head, such as the super elastic cage implantation [
25], the biomaterial-loaded allograft threaded cage [
26], the umbrella-shaped memory alloy femoral head support device [
27], PLGA/TCP scaffold [
28], and cementation [
29]. In our study, we developed a lantern-shaped screw, which was designed to provide the achievement of surface at surface support for the femoral head to prevent its collapse, for the treatment of ONFH. The purpose of this study was to investigate the efficacy and safety of a lantern-shaped screw loaded with autologous bone for the treatment of pre-collapse stages of ONFH.