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August 4, 1978

Early Diagnosis and Malignant Disease of the Hip-Reply

Author Affiliations

The Johns Hopkins Hospital Baltimore

JAMA. 1978;240(5):434. doi:10.1001/jama.1978.03290050024006

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Our article stresses two points. All hips that ache are not arthritic, and malignant disease will not be diagnosed if it is not included in the differential. The fact that these patients had been symptomatic for an average of nearly six months before referral to our unit and that a diagnosis of malignant disease was made on the average of six days after referral suggests that earlier diagnosis could have been made had it been considered. For example, two patients had not previously received roentgenograms of the affected areas. Death or total incapacitation occurred an average of four months after diagnosis in five of our seven patients. Thus, late diagnosis and treatment were ineffective. Whether these specific patients would have benefited from earlier diagnosis is circumspective. Given the natural history of malignant disease, however, the hope for patients such as these rationally comes from earlier diagnosis and treatment.