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The intra-articular injection of hydrocortisone acetate is commonly used in the treatment of osteoarthritis, although its action in this disease has received less careful study than in rheumatoid arthritis. In 1955 a less soluble ester, hydrocortisone tertiary-butylacetate (TBA) was developed for intraarticular therapy with the claim that its effects were more pronounced and of longer duration (Hollander, Brown, Jessar, Udell, Smukler, and Bowie, 1955 The fortnightly assessments comprised the following measurements:Walking time over 75 yards; Range ofjoint movement and limitation of extension determined by a goniometer; Tenderness (graded 0 = none, 1 = slight, 2 = definite, 3 = wincing, 4 = withdrawal and/or exclamation); Pain (graded 0 = none, 1 = slight on walking, 2 = marked on walking, 3 = mild at rest, 4 = severe at rest).Radiographs of the knees were obtained before and after the trial. ResultsThree patients failed to complete the trial; two defaulted after the second course of injections, and one developed an unrelated disease after the third injection of the second course. This resulted in five knees not receiving a course ofplacebo injections.The specific data (walking time, etc.) derived from the first assessment in each treatment period were compared with the same measurements made at the four assessments in the succeeding 8-week rest period. Changes in walking time and joint movement were estimated as a percentage of the pretreatment measurements; changes in limitation of extension were calculated as a percentage of maximal joint range (145°). Although pain and tenderness were graded at each assessment, because this parameter is entirely subjective, differences were calculated on the basis of improvement and no improvement. In this way the effect of treatment, both immediate and sustained, was calculated for each knee for each of the three treatments. The mean change for each of the three groups (hydrocortisone, TBA, and placebo) between pre-treatment assessments and each of the four post-treatment assessments was analysed by conventional statistical methods.

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