More on HIV-associated Kaposi's sarcoma.

n engl j med 358;5 www.nejm.org january 31, 2008 535 tion) over a treatment period of 5 weeks in patients with osteoarthritis of the hip. Initially, the manipulative therapy was more effective in reducing pain and increasing function, but it lost efficacy over time. Additional clinical studies are warranted to obtain information about the efficacy of manipulation therapy and to determine whether there are particular subgroups of patients who are most likely to benefit from this intervention.1 I agree with Beaty et al. that there are now a number of effective surgical options, before a total hip arthroplasty, that may be effective in patients with osteoarthritis of the hip. Arthroscopic or open operative techniques used for anterior femoral impingement resulting from acetabular dysplasia are reported to reduce pain and improve function and to prolong the time until total hip arthroscopy is required.2,3 In addition, osteotomies of the femur, pelvis, or both can be performed to prolong the time to total joint arthroplasty. Although there are data on the efficacy of these techniques from case reports and reports on small case series, additional long-term follow-up is still required to determine which patient population with osteoarthritis of the hip is likely to benefit from these joint-saving techniques.