title: Low molecular weight heparin prevents the progression of precollapse osteonecrosis of the hip.
abstract: BACKGROUND
  Hypercoaguable state has been indicated as a major risk factor in predisposing the idiopathic osteonecrosis of the hip. Furthermore, many studies have demonstrated that low molecular weight heparin (LMWH) can reverse the pathophysiology of the osteonecrosis of the hip in thrombophilic patients.
  
  
  OBJECTIVE
  Determine whether LMWH can prevent the progression of idiopathic osteonecrosis of the hip.
  
  
  METHODS
  A retrospective study of 36 patients who had bilateral idiopathic osteonecrosis with at least one hip in the pre-collapsed stage (Ficat & Arlet stage I-II) was conducted. In the study group, 18 patients (26 hips) received 6,000 units of Enoxaparin daily for 12 weeks. In the control group, 18 patients (23 hips) received no Enoxaparin. All patients were given radiographic evaluations every three months for a minimum of24 months.
  
  
  RESULTS
  At the last follow-up, 15 hips (57.7%) from the study group and five hips (21.7%) from the control group were observed to remain in the pre-collapse stage (p = 0.042). Coagulation disorder was observed in seven patients (38.9%) of the experimental group and five patients (27.8%) of the control group. One patient from the study group exhibited hematuria with spontaneous resolution after the course ofEnoxaparin injection.
  
  
  CONCLUSIONS
  A progression rate of idiopathic osteonecrosis of the hip from the pre-collapse stage to the collapsed stage was found to be significantly lower in patients who received LMWH.
authors.affiliation: Department of Orthopedics, Phramongkutklao Hospital, Bangkok, Thailand
authors.forename: Thanainit
authors.initials: T
authors.lastname: Chotanaphuti
authors.affiliation: Department of Orthopedics, Phramongkutklao Hospital, Bangkok, Thailand
authors.forename: Sompob
authors.initials: S
authors.lastname: Thongprasert
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
authors.forename: Artit
authors.initials: A
authors.lastname: Laoruengthana
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D005271:Femur Head Necrosis / Q000188:drug therapy* / Q000503:physiopathology; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016896:Treatment Outcome
chemical_list: D006495:Heparin, Low-Molecular-Weight