The Mechanical Treatment of 
Senile Coxitis. 
BT 
HENRY LING TAYLOR, M. D. 
RKFItINTKl) FROM 
Clie NrU) York fWr&tcal .Journal 
for December 15, 1888. Reprinted from the Aew York Medical Journal 
for December 15, 1888. 
THE MECHANIC A L TREATMENT OF 
SENILE COXITIS* 
By HENRY LING TAYLOR, M. D. 
By “senile coxitis” (malum cox;e senile) I understand 
a rheumatoid affection of the hip joint occurring in old 
people and characterized clinically by local pain, muscular 
spasm, wasting, stiffness, and disability, hut never showing 
a tendency to suppurate. It may or may not be associated 
with similar troubles in other joints. 
When the hip joint of an elderly person becomes af- 
fected in the manner indicated, the cause is usually referred 
to a dyscrasia with joint manifestations, called rheumatoid 
arthritis, an affection not confined to the aged and probably 
having small affinity with tuberculosis, gout, or rheumatism. 
Its characteristic local lesions are eburnation and atrophy of 
the bearings of the joint, with hypertrophy and prolifera- 
tion of its peripheral parts not subject to pressure. Some 
cases of senile coxitis may have a different causation and 
morbid anatomy with a similar clinical picture. 
The usual treatment is medicinal, dietetic, and local, but 
many patients go through the various stages of local sensi- 
tiveness and disability, sometimes with moderate constitu- 
* Read before the American Orthopaedic Association at its second 
annual meeting. THE MECHANICAL TREATMENT 
2 
tional reaction, often with long remissions of the active 
symptoms, until finally the affected joints become crippled 
and nearly or quite useless. Can anything be done for such 
of these helpless old people as seem likely to resist or have 
already resisted orthodox treatment ? 
It is stated that malum coxae senile sometimes follows 
directly on local traumatism, and while it must be admitted 
that some cases of impacted fracture of the neck of the 
femur may have been confounded with inflammatory trouble 
in the observations, we can not help noticing the positive 
effects of traumatism in determining or aggravating attacks. 
It would seem on general physiological grounds that the 
strain and pressure of attempted free locomotion must ag- 
gravate the local difficulty, and that an endeavor might rea- 
sonably be made to allay irritation and improve the local 
and general nutrition by efficient mechanical protection to 
the disabled hip joint. If it is feared that these old people 
can not or will not submit to mechanical measures, we have 
not found it so in our experience ; indeed, I am able to 
make the broader statement that adult or advanced life is a 
much less unfavorable factor in orthopaedic practice tlian is 
usually supposed. Nevertheless, in devising a plan of treat- 
ment for senile coxitis, unnecessary confinement of body 
and limb has been avoided. 
In several cases which had resisted previous treatment, 
and the patient seemed urgently to need help, we have tried 
the plan of applying counter-traction thoroughly, and then 
protecting the joint from all traumatism for a considerable 
period. The patient is put to bed with the long counter- 
traction hip splint and extra weight attached, the leg being 
supported in a sling. At the end of a month or six weeks 
we find the muscles about the hip joint softer, and position 
and mobility improved, and allow the patient to go about 
on the jointed supporting splint (“ Dows’s ”), which pro- OK SENILE COXITIS. 
3 
tects the hip joint from pressure, but allows motion at the 
hip, knee, and ankle. The patient is thus enabled to enjoy 
the benefit of fresh air and moderate exercise with a certain 
amount of healthy stimulation to the now (juiescent joint, 
through the protected and pressureless motion. If progress 
is not satisfactory, the traction in bed is repeated, and the 
patient again allowed to go about after a few weeks. 
Case I.—Mrs. W., aged fifty-seven years, came in March, 
1883, with the history of trouble in the left hip joint of two 
years’ standing, but she stated that she had had some tender- 
ness in several joints for four years. The trouble began in her 
right shoulder and had affected the elbows, wrists, right ankle, and 
one finger. The toes never got sore and the fingers were not de- 
formed. She stated that her general health had been good, but 
she looked delicate and rather older than she was. The tender- 
ness and pain in the joints had never laid her up and she had 
felt well throughout. About two years before she had stepped 
into a hole and hurt her foot, and for the past year had limped 
with the left leg. During the summer of 1882 she began to 
have difficulty in going up stairs and to feel weak and have pain 
in the anterior thigh muscles on motion, and stiffness in the 
left limb. She had noticed soreness in the left groin for two 
weeks, but had always supposed the pain to be due to muscular 
rheumatism, and never suspected that the hip was affected until 
told by her physician two weeks previously. 
On examination, tenderness, crepitus, and limited motion 
were found, to a greater or less extent, in several joints, notice- 
ably in the right elbow and both wrists. The left thigh was 
considerably flexed and adducted, and there was a coarse crepitus 
at the hip joint. She was very helpless, walking with difficulty. 
She was put to bed with long counter-traction splint and eight- 
een pounds extra weight for six weeks, and then allowed to go 
about on crutches, with a jointed supporting splint (“ Dows’s ”), 
which took the weight off the joint. 
The condition of the hip improved slowly, but perceptibly, 
from the start. Soreness became less, and position and motion 
at the hip improved. In the winter of 1884-’85 she was walk- 4 
THE MECHANICAL TREATMENT 
ing readily around the house without crutches. The following 
summer (1885) she went to Richfield Springs, and took the ap- 
paratus off to take the baths; she found she could walk so well 
that she did not put it on again. When I saw her in Novem- 
ber, 1885, she walked very nicely, and had extensive motion at 
tne hip in all directions, with very little tenderness. The con- 
dition of the other joints seemed no better; crepitus, stiffness, 
and tenderness were about the same as before. In a letter 
just received, her daughter writes, in answer to my inquiry ; 
“We think mother quite as active as any member of the family ; 
a little lame, but so much better than we ever expected to see 
her, [we] do not notice the limp. . . . She is very comfortable, 
as far as the rheumatism will allow ; her hands are quite weak 
and somewhat out of shape.” 
Case II.—Mrs. R., aged fifty-eight, came in February, 1883. 
She was a large, strong, young-looking woman, had always had 
excellent health, and her family history was good. Eight years 
previous to coming the patient noticed that the right foot was 
rotated out; when she turned it in, it caused pain on the inside 
of the knee; this pain also came when she got fatigued. It 
gradually grew worse, and for the past four or five years she 
had given up one duty after another, owing to lameness and in- 
creased pain. She had always supposed the knee to be at fault, 
and neither she nor her doctor had ever suspected the hip. For 
two years past she had been obliged to put a pillow under the 
right knee in order to be able to sleep, and the knee had received 
electrical and other treatment. 
Examination showed the right thigh considerably flexed and 
adducted. Mobility at the hi]) was almost gone, except flexion 
and extension through a few degrees. She never had pain ex- 
cept when tired—then it came on the outer aspect of the right 
knee; when she was still more tired, in anterior part of thigh, 
hip, and back. She had a moderate lameness. The functions 
of the knee were normal. 
The patient was put to bed, with the long hip splint, sixteen 
pounds extra weight, and sling, for a month, during which time 
the thigh muscles relaxed, flexion was reduced, and pain was 
latterly absent. She was then allowed to get up on the jointed OF SENILE COXITIS. 
5 
supporting splint (“Dows’s”), and in a few days was walking 
nicely with the apparatus only, and feeling no pain. 
The patient did well, but had on a few occasions some recur- 
rence of pain, and once or twice was put to bed for two weeks 
with counter-traction as before. In January, 1885, the appa- 
ratus was removed, and she was discharged cured, walking 
easily, with but slight limp; position of limb almost normal, 
mobility increased. When last seen, over a year after her dis- 
charge, she got around very readily and comfortably, having 
retained what she had gained. 
These results have been sufficiently encouraging to war- 
rant the belief that many cases of intractable senile coxitis 
may be much relieved and an unserviceable limb restored to 
comfortable use by a plan of treatment such as the one 
described. 
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