Osteoarthritis is the most common joint pathology which primarily affects the older population. The disease is characterized by unique pathological changes in some synovial joints, predominantly affecting the articular cartilage, but also entire joints, including the synovial tissue and subchondral bone. The remarkable growth of research on normal and abnormal biology of tissues in the articulating joint, including the application of novel molecular biological approaches and new imaging techniques, is reflected in this volume. It describes the current state of knowledge and helps to further understand the etiopathology of osteoarthritis, hopefully leading to early detection of the disease and novel treatment modalities. The volume contains contributions and discussions from a select group of investigators, all experts in this field, who met at the conference "The Many Faces of Osteoarthritis", held in June 2001 at Lake Tahoe, to acknowledge Klaus E. Kuettner and his contributions to osteoarthritis...

Arthritis Research: Methods and Protocols, Second Edition expands upon the first edition to present new and current techniques for the research of arthritis and related conditions. A compendium of leaders in the field contribute chapters that cover practical research methods such as the intravital multiphoton microscopy technique, techniques for evaluating exhausted CD8 T cell and for studying nucleic acid sensors and their effects, methods for in vivo tetracycline-controlled transgenic mice and T cell receptor transgenic mice, protocols to detect V(D)J recombination products and microRNA, and the technique to make bleomycin-induced dermal fibrosis. Written in the successful Methods in Molecular Biology series format, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible protocols, and notes on troubleshooting and avoiding known pitfalls. Authoritative and easily accessible, Arthritis Research: Methods and Protocols, Second Edition will serve both professionals and novices with state-of-the-art techniques pertaining to this fascinating research field.

Advances in Materials Science and Implant Orthopedic Surgery brings together experts from major university hospitals, materials scientists specializing in bio-materials, and development engineers working for implant manufacturers to address such issues as: mechanisms of fixation; foreign-body immune response; generation and consequences of ionic and wear debris; materials selection, design and manufacturing schemes; and surgical techniques to maximize the safety and efficacy of the devices.

An introductory text on bone metastases written by experts from various disciplines. It covers the basic principles of surgery in bone cancer, classification, medical treatment, radiotherapy, surgical treatment, incidence and pain relief. The steady progress in diagnosis and treatment of bone cancer in the last decade has dramatically changed the prognosis of cancer patients, improving significantly the overall survival rate and quality of life. Multidisciplinary treatments that combine surgery, radiotherapy and chemotherapy, as described in this book, show significantly improved results and an above average survival rate. Some hematologic malignancies that involve bone may be cured with systemic chemotherapy or radiotherapy, but for most patients with bone metastases, pain relief is the goal of therapy.

This book follows a context-based approach to management of early-onset scoliosis (EOS) in countries with limited resources in education, finance, and research. Due to the great variety in etiology, onset age, progression rate, and severity associated with EOS, it calls for a unique treatment plan. This book enumerates the optimal provision of surgical and non-surgical services, from education/training of local surgeons, to effective teamwork, to implementing an effective data collection system; helping the surgeon to gain a hands-on experience. It also illustrates the successful execution of deformity correction using real life experiences from countries in Asia, Africa, and Latin America. Key Features Discusses biomedical principles that will help to get universally standard implants that are credible and affordable for countries with limited resources. Specific surgical Guidelines and the ability to develop evidence-based practice for this service would be an interesting read for surgeons working in global organizations as well as to local surgeons. First book to focus on countries with limited resources for the management of early onset scoliosis.

Growth Hormone is a fitting addition to the Endocrine Updates Series. The aim of these publications is to provide the clinician with cutting-edge, yet succinct, access to the latest advances in endocrinology. Current interest in this rapidly evolving area of endocrinology makes this a timely and important update. Growth Hormone joins Dr. Fagin's Thyroid Cancer in continuing the standard of excellence as the fourth volume in this series of topical updates. Shlomo Melmed, MD, Series Editor, Endocrine Updates Ten years ago, many endocrinologists were still skeptical that growth hormone (GH) played an active role in adult metabolism. This is, perhaps, surprising given that GH deficiency (GHD) in adulthood had been `recognized' as long ago as the 1960s. During the last ten years studies have shown that GHD in adulthood is a far-reaching syndrome associated with abnormal body composition, reduced bone mineral density with an increased fracture rate, increased cardiovascular morbidity and impaired cardiac function, as well as reduced exercise performance and decreased psychological well-being. Importantly, it is also clear, from placebo-controlled trials, that GH replacement therapy can normalize body composition, increase bone mineral content and improve the cardiovascular risk factor profile. GH replacement therapy also improves cardiac performance and exercise capacity, increases muscle strength and improves well-being and quality of life. The aim of Growth Hormone is to provide a critical update of current knowledge about adult GHD and the future role of GH/IGF-1 in adult medicine. For this purpose, contributions from a number of research groups have been invited. It is my hope that the book may not only serve as an introduction to the field, but also stimulate further research within this exciting area.

Paris October 10th, 1929 - Kyoto October 15th - 20th, 1978

This book presents an analysis of the stress distribution and contact stresses in severe rheumatoid wrist after total wrist arthroplasty. It assesses and compares the load transfer throughout the joint and contact pressure at the articulations. The data obtained from this study is of importance as this provide greater evidence to the benefits of total wrist arthroplasty in rheumatoid arthritis patients.

Integrated Biomaterials Science provides an intriguing insight into the world of biomaterials. It explores the materials and technology which have brought advances in new biomaterials, highlighting the way in which modern biology and medicine are synergistically linked to other key scientific disciplines-physics, chemistry, and engineering. In doing so, Integrated Biomaterials Science contains chapters on tissue engineering and gene therapy, standards and parameters of biomaterials, applications and interactions within the industrial world, as well as potential aspects of patent regulations. Integrated Biomaterials Science serves as a comprehensive guide to understanding this dynamic field, yet is designed so that chapters may be read and understood independently, depending on the needs of the reader. Integrated Biomaterials Science is attractive to a broad audience interested in a deeper understanding of this evolving field, and serves as a key resource for researchers and students of biomaterials courses, providing all with an opportunity to probe further.

Magnesium Biomaterialsprovides a succinct up-to-date overview of Magnesium biomaterial development, critically examines the types of in vitro experiments that may be performed, and investigates the numerous variables that affect Magnesium biodegradation when undertaking these experiments. This work also discusses the direction in which current Magnesium biomaterial development is heading and the necessary steps for future development of this field. Information is drawn from numerous multi-disciplinary sources to provide a coherent and critical overview. Magnesium Biomaterialsis ideal for researchers in thearea of bio-Mg, companies interested in exploring their own alloys, and for researchers working with other biodegradable materials who are seeking a cross-platform understanding of material performance."

Focusing on the most current, cutting-edge, innovative, and advanced arthroscopic techniques for wrist and hand, elbow, shoulder, hip, knee, ankle, foot, and spine, this book presents orthopaedic surgeons with the detailed procedures needed to stay competitive in the age of managed care. With contributions from specialist leaders in orthopaedic and arthroscopic surgery, the text is supplemented by full-color arthroscopic views and custom illustrations, detailing complex procedures for rotator cuff tear, TFCC repair, meniscus repair, ACL reconstruction, intraarticular fractures and many others. Special sections on laser applications in arthroscopy and office arthroscopy make this volume a must for every practicing orthopaedic surgeon.

P. Bedeschi ture-dislocations, and Monteggia lesions. This is the second volume in the mono- graphic series Current Coneepts in Orthopae- Each chapter is interesting because it re- die Surgery, published with customary distin- flects an important personal experience and ction by Aulo Gaggi, under the direction of contains an honest critical evaluation of the the Institute of Clinical Orthopaedics and results. Traumatology of the U niversity of Modena. The two following chapters give an upda- The subject of this text, "Traumatic lesions ted analysis of the neural and vascular com- of the elbow", is very current and we believe it plications of elbow trauma from a pathogene- worthy of more attention than it has received tic, clinical, and therapeutic standpoint. in re cent years. The next chapter is an update on nonu- The text begins with a chapter on the phy- nions of the elbow with special reference to siopathology of the elbow, which is important therapeutic problems. because of some interesting links between The difficulty of long-term evaluation of trauma and functional damage as weil as bet- treatment of radial head fractures is examined ween some traumatic lesions and consequent in two interesting chapters that describe the treatment. long-term results of radial head resection and Next are two important chapters on over- prosthetic replacement.

Surgical management of joint problems has progressed drama tically in the past few years. Clearer understanding of the patho genesis of joint disorders and recent additions to our knowledge of joint mechanics have mage formerly unimagined procedures possible. Moreover, tremendous advancement in implant tech nology offers us a wider variety of surgical procedures and a better chance of obtaining satisfactory results. At the same time, alternative bone-preserving procedures, such as osteotomy, in the weight-bearing joints are still of great significance in selected cases. In this context, it is clear that international collaboration and coordination of scientific endeavours is crucial. Over the last decade, thanks to the great assistance given by contributors to this book, we have tried to coordinate our endeavors on the interna tional level without being restricted to our own societies. There fore, it was fitting that the symposium was held in an effort to bring together experts in the field of joint surgery to share their specialized knowledge. We hoped that the free interchange of ideas would bring about an updated understanding and provide knowledge essential to the treatment of joint disease. KAzuSHI HIROHATA Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Part 1. Recent Advances and Problems in Total Joint Replacement Biomechanics of Endoprostheses of the Hip and Adaptive Reactions of the Bone B. KUMMER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Management of Femoral Bone Stock Deficiency in Total Hip Replacement H. P. CHANDLER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . . Bone Grafting of Acetabular Deficiencies in Total Hip Replacement A. H. WILDE, B. N. STULBERG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ."

1 Indikationsstellung fur gelenkerhaltende und gelenkersetzende Behandlungsverfahren.- Gelenkerhaltende Eingriffe.- Gelenkersetzende Eingriffe.- 2 Technische Besonderheiten fur die Implantation bikondylarer Prothesen.- 3 Management der Fehlstellung totalkondylarer Prothesen.- Allgemeine Bemerkungen.- Praoperative Planung.- Anatomische und klassische Resektion.- 4 Behandlung der Beugekontraktur.- Behandlung der milden Form der Beugekontraktur (Grad I bis 10 Grad Flexion).- Behandlung der mittelschweren Form der Beugekontraktur (Grad II zwischen 10 und 30 Grad).- Behandlung der schweren Form der Beugekontraktur (Grad III mehr als 30 Grad).- 5 Behandlung der Extensionskontrakturen.- Chirurgisches Vorgehen.- 6 Management der Varusfehlstellung.- Management der leichten Varusgonarthrose.- Management der massigen Varusgonarthrose.- Management der schweren Varusfehlstellung.- 7 Management der Valgusfehlstellung.- Behandlung der extremen Valgusfehlstellung mittels Korrekturosteotomie.- 8 Management der aseptischen Prothesenrevision.- Praoperative Planung.- Zugangswege bei Revision.- Entfernung der alten Implantate.- Technik der aseptischen Kniegelenksrevision.- Anhand des Kniesystems Wallaby III soil die Technik der Revisionsoperation erklart werden.- 1. Standardisierte Operationstechnik unabhangig vom Knochendefekt.- 2. Die Wiederherstellung der ligamentaren Stabilitat.- 3. Wiederherstellung der knoechernen Integritat.- 4. Sichere Fixation der femoralen und tibialen Komponente.- Klinisches Beispiel.- 9 Management der septischen Prothesenrevision.- Klassifikation und Ursachen.- Wundheilungsstoerung/oberflachlicher Infekt.- Der Fruhinfekt.- Der Spatinfekt.- Der zweizeitige Wechsel.- Der einzeitige Wechsel.- Wahl des Implantates.

Professor B.G. WEBER has once again and in a very timely fashion produced a superb book on an orthopaedic subject of great importance. "The Extemal Fixator" is the most comprehensive text on the subject in orthopaedic literature to date. Professor WEBER thoroughly discusses extemal fixation with c1arity, organization, profuse illustrations and roentgenograms. Professor WEBER acknowledges that the use of extemal fixation in orthopaedic surgery is not newand traces its history over the years. He points out c1early the fact that though at various times the "method" has experienced periods of disrepute, modem sophistication, improved technology and a better understanding of its philosophy have given the system a newand perhaps permanent place in the armamentarium of the orthopaedic surgeon. All methods of treatment have critics as well as supporters, and not infrequently the strongest criticisms are the result of poor understanding of the philosophy proposed and its proper implementation. Professor WEBER, in his carefully detailed and well illustrated book, has made it abundantly c1ear that the use of extemal fixators in the treatment of fractures must be c1early understood by the orthopaedic surgeon in order to obtain satisfactory clinical results. His discussion of its philosophy, pathomechanics and technology are most comprehensive and leave "no stone untumed" and because of this the book represents a most comprehensive text on the subject.

Joint-preserving techniques for conservative and operative treatment in gonarthritis are developing rapidly. This book outlines the latest treatment options for joint preservation in osteoarthritis. These include drug treatment, viscosupplementation, arthroscopy, cartilage transplantation and osteotomy. Experts have reviewed and updated each area including their own personal experience.

Recent research, especially in fields of orthopaedic surgery and rehabilita tion, point to the importance of periodic, moderate stress for maintaining normal structure and function of tissues. Moreover, growth and healing of load-bearing tissues such as bone, cartilage, and intervertebral disc are especially dependent upon stress-related stimuli. Extreme levels of stress, however, are usually detrimental to tissue integrity, and most treatment regimens today address problems related to trauma and other conditions of abnormally high stress. Therefore, the purpose of this book is to bring together experts in fields of tissue nutrition and growth in order to review previous work and examine new ideas and results concerning the importance of mechanical stress in tissues. This book is unique in that the topic of tissue nutrition and growth, especially related to possible benefits of periodic moderate stress, has never been addressed comprehensively, drawing together experts on vari ous tissues and organs. One objective is to focus attention on tissue nutrition where controversy still exists regarding basic mechanisms of metabolite transport and fluid homeostasis within the interstitium. An other objective is to examine the pathophysiology of tissue compression and discuss strategies to improve viability. Tissues which are treated in this book include bone, cartilage, intervertebral disc, lung, nerve, skeletal muscle, umbilical cord, synovium, skin, and subcutaneous tissues. Based upon these objectives, this book is primarily addressed to students, inves tigators, and teachers in fields of physiology, biochemistry, biomechan ics, exercise, orthopaedic surgery, rehabilitation, and sports medicine."

Clinical biomechanics is a rapidly changing field with an increasingly wide appeal. While the core subjects of biomechanics remain the behavior of bones, joints, ligaments, and muscles, this book focuses on more clinical aspects such as artificial joints, tissue transplantations, and the effects of disease on biomechanical properties. Also featured are special studies of the hand, spine, vascular system, and the analysis of three-dimensional motion.
Based on the 20th Annual Meeting of the Japanese Society for Clinical Biomechanics and Related Research, this book provides an overview of the subject as well as describing many exciting new concepts and innovative methods for analyzing biomechanical systems. It should appeal across a wide spectrum of professions, proving indispensable to everyone from orthopedic surgeons to engineers with an interest in biology.

After my appointment as head of the Orthopaedic Department in the Surgical Clinic of the Wilhel- mina Gasthuis in Amsterdam, January 1953, I have had the privilege of a close and daily co-operation with my second-incharge M. J. Kingma. Amongst other problems, reconstructive surgery with the aid of bone-grafting captured the interest of both of us. In vol. XII, fasc. 3 (1960) of the Archivum of calf bone preserved by refrigeration was Chirurgicum Neerlandicum Kingma wrote: 'The use introduced into surgery in the Netherlands by Meiss in 1951. After the appearance of Meiss' reports on his favourable results, many other surgeons wished to employ this method and in order to cope with the numerous requests for material, a national bone transplantation service for calf bone was in- stituted in 1952 under the patronage of the Netherlands Red Cross with Kingma as its medical direc- tor'. In 1953 we considered homogenous graft to provide a better 'biological intermedium' than calf bone graft. Consequently we developed a bone-bank for homogenous grafts in our department from that date. After 18 years of experience we have been able to demonstrate clinically and radiologically that in some cases a 'biological fixation' can be maintained with the homogenous graft during the recon- struction by 'graduated' function. Kingma controlled the results and arranged the data.

J. SCHATZKER Friedrich Pauwels first postulated that excessive osteotomies and in particular on a group ofJ 09 joint pressure could cause the destruction of ar- osteotomies followed up for 13-15 years after ticular cartilage and lead to osteoarthritis, and surgery. that the reduction of this pressure would bring Erwin Morscher supports the long-term re- about regeneration of articular cartilage and re- sults of Bombelli and Schneider in his analysis gression of the disease. The first chapter of this of a study of over 2,000 osteotomies performed book is a synthesis of Pauwels' lifelong devotion in several Swiss centers. to the biomechanics of the hip. It presents the He also presents a careful analysis of his reader with a clear exposition of the intertro- own smaller series. Based on all these data, he chanteric osteotomy as a procedure based on defines for us the ideal parameters which clear biomechanical principles, and illustrates should be present in order to make the patient how biomechanical regeneration of the joint can an ideal candidate for an intertrochanteric os- be influenced by a reversal of the mechanical teotomy.

Different views about the biomechanics of the knee joint and late re construction of ligamentous injuries underline the obstacles impeding the establishment of generally acceptable principles for the treat ment of such lesions. As late as June 1976, HUGHSTON emphasized in the Journal of Bone and Joint Surgery that in spite of excellent anatomic studies, substantial uncertainty still prevails in knee joint surgery. Even the signifi cance of the anterior drawer sign for ruptures of the anterior cru ciate ligament is interpreted quite diversely, as illustrated in a comparison of HUGHSTON, GIRGIS, TORG, and SCHIECK, who give varying opinions concerning the indication related to the age of the patient or possible earlier joint damage as well as concerning the prognosis for untreated knee joints. The question still remains as to how often an intra-articular ligamentous replacement should be carried out in addition to extra-articular techniques (0 'DONOGHUE, SLOCUM, NICHOLAS, HUGHSTON). Lastly the question of synthetic ligament replacement must be clarified. After basic research has well advanced, clinical ex perience must be discussed. Statements concerning the therapeutic value of diverse procedures based solely on knowledge of the literature remain problematic. For this reason a workshop was held at the University of Heidelberg in the Orthopedic Clinic (Head: Prof. Dr. H. COTTA) in June 1977, with the aim of bringing together representatives of the different leading schools in a round table discussion to comment on still unsolved ques tions."

Endoscopic neurosurgical interventions gain in importance. This book gives adetailed description of the recent indi- cations of endoscopic procedures inmodern neurosurgery. They include endoscopic stereotaxy, endoscopic evacuations of intracerebral hematomas, cysts and abscesses as well as endoscopic interventions on brain tumors. An extended over- view about the usable endoscopes and the operative equipment is pointed out

Meniscal transplantation has become an attractive option in selected patients with incapacitating knee pain. This book discusses all aspects of meniscal transplantation, covering the use of both allografts and meniscal substitutes, including collagen and polyurethane implants. Acknowledged experts in the field review the basic science, explain indications, and describe surgical techniques and the results achieved to date. All the material is up to date, with information on new implants, new techniques, and new surgical approaches. Future trends in the treatment of meniscal lesions are also discussed as we move towards the application of regenerative strategies to restore meniscus function. "

At the writing of this book, the United States is in the midst of an intense public debate concerning a widely perceived need for reform of the Health Care Delivery System. The reform is primarily aimed at the provision of medical insurance to a large segment of the population currently deprived of that coverage and to the reduction of the escalating costs of medical care. Solutions to the existing problems have been elusive because the causes of the dilemma are multifactorial, complex, and diffucult to identify clearly. There is, however, general consensus that the use and abuse of technology has played a major role in the growing costs of medical care. The importance of fracture care in the overall financing of the health care reform is significant, since injuries to the musculoskeletal system are responsible for a very large percentage of the general expenditures in this area. The cost is not limited to hospitalization and professional services, but also impacts the economy with tempo rary or permanent interruption of individual productivity."