Pulsed radiofrequency therapy ameliorates steroid-induced osteonecrosis of the femoral head by promoting nerve growth factor production.

Steroid-induced osteonecrosis of the femoral head (SONFH) is characterized by devastating collapse of the femoral head. Pulsed radiofrequency therapy (PRF) has been widely used in different pathophysiological conditions. Here, we investigated the therapeutic benefit of PRF in SONFH and investigated the role of neurotrophins in the treatment effect of PRF therapy. The beneficial effect of PRF therapy in SONFH patients and the rat model of SONFH was evaluated. The effect of PRF therapy on the levels of neutrotropic factors was examined by ELISA. The functional engagement of nerve growth factor (NGF) in alleviating SONFH progression was investigated in the bone marrow cells and animal model. PRF alleviated SONFH progression in the patients and rat model. PRF therapy increased the plasma levels of NGF in SONFH patients and rat model. NGF treatment prevented Dex-induced cell death and steatosis in bone marrow cells, promoted the expression of osteogenic markers, and ameliorated SONFH progression in the rat model. NGF neutralization counteracted the effect of PRF therapy in the rat model of SONFH. Our findings suggest that PFR therapy ameliorates SONFH progression by promoting NGF production. Supplementary Information: The online version contains supplementary material available at 10.1007/s10616-025-00871-y.