Early Diagnosis and Malignant Disease of the Hip

To the Editor.—  The article entitled "Malignant Disease Mimicking Arthritis of the Hip" by Meals et al (239:1070, 1978) ends with a sentence of usually acceptable medical jargon: "Early diagnosis is paramount for effective treatment."However, the seven patients whose cases were summarized did not necessarily receive less effective treatment because of delay in diagnosis. As examples, two of the patients had an "outcome" with "control" of their disease (chronic myelogenous leukemia and Hodgkin's disease) despite the delay in diagnosis. Of the others who had metastatic cancer to the hip, the one whose symptoms were of shortest duration (one-half month) had a poorer outcome than those whose diagnoses were missed for longer periods (up to 16 months).Other examples, from their case summaries, of patients whose treatment would not necessarily be more effective if the "malignant disease" of the hip were diagnosed early included the patients with metastatic cancer from