Cortisone in the treatment of degenerative joint disease of the hip.

Degenerative joint disease of the hip, often called osteo-arthritis, or malum coxae senilis, a clinical condition known for the pain and deformity it causes, is the most disabling form of degenerative joint disease. The cause of the condition is unknown; trauma, an old dislocation of the hip, a slipped epiphysis, Legg-Perthes disease, and senescent degenerative changes have all been suggested (Steindler, 1951) as the most likely factors in its formation. The pathology comprises fibrillation, erosion, and eburnation of the articulating cartilage and the production of exostoses of bone. The femoral head may show variable degree's of flattening, and cystic changes may be localized in it as well as in the acetabulum. Sclerosis of the acetabular rim is also seen. Later fibrosis of the joint capsule and peri-articular tissue may also occur and lead to further restriction of joint mobility. Because of the dramatic effects of cortisone in rheumatoid arthritis, its use experimentally in malum coxae senilis seemed worthwhile even though the pathology of the latter disease differs markedly from that of rheumatoid arthritis. This series of experiments was also prompted by the differences in clinical results following treatment of degenerative joint disease (including malum coxae senilis) with ACTH and cortisone as reported in the literature. Hench and others (1950) reported a patient with degenerative joint disease of one knee who received cortisone for the treatment of leukaemia cutis, and noted relief of pain and stiffness of the involved knee. Boots and others (1951) reported the treatment of eleven patients with malum coxae senilis; they observed subjective improvement in ten patients and increased range of motion in all patients. Brown and others (1951) reported their observations after treating eight patients with malum coxae senilis; two were improved, while six obtained neither subjective nor objective benefit. Thorn and others (1951) described alleviation of symptoms in a patient treated with ACTH who had generalized degenerative joint disease with involvement of both hips. Dale (1950a, b) reported treating two cases of osteo-arthritis who experienced dramatic relief of symptoms. These published reports suggest the need of a controlled study in the therapeutic evaluation of this condition.