I read with interest the recent letter to the editor from Dr. Margules (1). Those of us who trained with Dr. Joseph Hollander at the University of Pennsylvania School of Medicine remember the patients for whom he used periodic injections of steroids to treat osteoarthritis of the hip. The injections were instilled without fluoroscopic direction, and the site of injection was based simply on anatomic landmarks. These injections were reserved for patients who could not or would not submit to hip arthroplasty and were given every 8–12 weeks, as needed.
Dr. Hollander was one of the developers of triamcinolone hexacetonide (Aristospan). He was convinced that the longer steroid crystal was more insoluble and contributed to what he believed was the significantly prolonged duration of action of this preparation compared with that of the other repository steroids available (2). In a study of the rheumatoid knee, Blyth et al reported increased efficacy with triamcinolone hexacetonide compared with triamcinolone acetonide (3).
Many of us who still use Aristospan are convinced that this compound has a significantly longer duration of action than other steroid preparations and is thus more effective and may be able to be used less frequently. One wonders whether Dr. Margules has had experience using triamcinolone hexacetonide rather than triamcinolone acetonide.