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The Scientific World Journal
Volume 2014, Article ID 347813, 6 pages
Research Article

Enoxaparin Prevents Steroid-Related Avascular Necrosis of the Femoral Head

1Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany
2Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
3Department of Pathology, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
4Department of Orthopedic and Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
5Department of Orthopaedic and Spine Surgery, AGAPLESION EV. BATHILDISKRANKENHAUS gemeinnützige GmbH, Maulbeerallee 4, 31812 Bad Pyrmont, Germany

Received 19 February 2014; Revised 6 June 2014; Accepted 11 June 2014; Published 2 July 2014

Academic Editor: Anastasios V. Korompilias

Copyright © 2014 Rainer Beckmann et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Nontraumatic osteonecrosis of the femoral head is still a challenging problem in orthopedic surgery. It is responsible for 10% of the 500,000 hip replacement surgeries in the USA and affects relatively young, active patients in particular. Main reasons for nontraumatic osteonecrosis are glucocorticoid use, alcoholism, thrombophilia, and hypofibrinolysis (Glueck et al., 1997; Orth and Anagnostakos, 2013). One pathomechanism of steroid-induced osteonecrosis is thought to be impaired blood flow to the femoral head caused by increased thrombus formation and vasoconstriction. To investigate the preventive effect of enoxaparin on steroid-related osteonecrosis, we used male New Zealand white rabbits. Osteonecrosis was induced by methylprednisolone-injection ( mg/kg body weight). Control animals were treated with phosphate-buffered saline. Treatment consisted of an injection of 11.7 mg/kg body weight of enoxaparin per day (Clexane) in addition to methylprednisolone. Four weeks after methylprednisolone-injection the animals were sacrificed. Histology (hematoxylin-eosin and Ladewig staining) was performed, and empty lacunae and histological signs of osteonecrosis were quantified. Histomorphometry revealed a significant increase in empty lacunae and necrotic changed osteocytes in glucocorticoid-treated animals as compared with the glucocorticoid- and Clexane-treated animals and with the control group. No significant difference was detected between the glucocorticoid and Clexane group and the control group. This finding suggests that cotreatment with enoxaparin has the potential to prevent steroid-associated osteonecrosis.