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.

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.

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.

Sharmila Majumdar In the area of osteoporosis and skeletal changes, it is currently accepted that bone mineral density (BMD), widely used for screening, monitoring and assessing therapeutic efficacy, does not adequately explain the pathogenesis of osteoporosis, the process of aging, or the therapeutic efficacy of various treatments. In this context, trabecular micro- architecture has enormous potential to contribute to understanding the pathophysiology of osteopor.osis and therapy assessment. The use and value of noninvasive imaging and quantitative image analysis and processing of trabecular bone micro-architecture have increased dramatically due to recent advances in instrumentation and software. This emerging field is diverse, interdisciplinary, and encompasses many different imaging modalities. Interested researchers include those involved in technique development, basic science and animal studies, as well as clinical researchers and practicing physicians. With the growth of this area of research, a group of investigators at the 11th Interna- tional Workshop of Bone Densitometry, 1 concluded that a forum dedicated to this matter was urgently needed. With this agenda, Dr. Peter Ruegsegger organized the first sympo- 2 sium on conjunction with the 10th Conference of the European Society of Biomechanics. The symposium on Bone Architecture and Competence was a two-hourlong event which resulted in five chapters in Bone Research and Biomechanics, edited by G. Lowet, P. Ruegsegger, H. Weinans, and A. Meunier, published by lOS Press, 1997. The second symposium was held as a pre-symposium to the 12th Workshop on Bone Denistometry,3 and flourished as a daylong event.

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

Cervical laminoplasty for the treatment of ossification of the posterior longitudinal ligament was developed and refined in Japan during the 1970s. Since that time, various cervical laminoplasty techniques have been further analyzed and modified, and have proven to be clinically successful. Until now cervical laminoplasty has been practiced primarily in Japan, and surgeons outside Japan had only limited access to the detailed English literature needed to make full use of the procedures. This book fills that gap in English information and provides a detailed, up-to-date guide to performing safe and effective cervical laminoplasty. Drawing on the latest knowledge from Japan, the book covers the history of cervical laminoplasty, surgical anatomy, basic procedures, modified procedures, possible complications, and perspectives on the future of expansive laminoplasty. This volume by leaders in the field is an excellent guide for all surgeons interested in laminoplasty.

In this updated edition of the German-language title "Neue Techniken - Kniechirugie", Professor Paessler, an experienced knee surgeon, provides a state-of-the-art survey of the field. In doing so he describes, among other techniques, how to reconstruct the anterior cruciate ligament (ACL), perform ACL revision surgery, manage a recent posterior cruciate ligament tear, treat cartilage lesions with microfracturing, reattach/replace detached cartilage fragment, perform a dome high tibial osteotomy. Professor Paessler is author of more than 150 publications (books and journals) and editor-in-chief of the "European Journal of Sports Traumatology and Related Research". An important resource for all trauma and orthopaedic surgeons and trainees.

Many residency programs in primary care specialties do not provide the education in pediatric orthopedics necessary to effectively deal with the field's challenges. Here, the authors present a framework for the effective evaluation of childhood musculoskeletal problems in a practical and problem-based manner. The volume contains case studies and over 200 illustrations.

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.

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. "

In recent years wrist problems have increasingly attracted the attention of orthopaedic and hand surgeons. Numerous advances have been achieved in functional anatomy, biomechanics, diagnosis, and treatment. There are, however, many controversial aspects to these problems. Many clinical and associated investigators from around the world have attempted to increase our knowledge of the wrist with enthusiastic and devoted studies. An international symposium was held at the Nagoya Castle Hotel, Nagoya, Japan from March 6th through March 8th, 1991 to further understanding and promote discussion of wrist problems among a representive international group. Approximately 300 participants from 16 different countries assembled for these discussions. This monograph consists of 40 selected papers based on presentations given at the international symposium. The topics are divided into six chapters: Functional Anatomy, Diagnosis and Basic Studies; Kienbock's Disease; Scaphoid Fracture, Distal Radius Fracture; Carpal Instability and Wrist Pain; and Wrist Arthroplasty. A number of unique observations as well as detailed surgical techniques were presented. These include topics such as the vascularity of the triangular fibrocartilage, radial wedge osteotomy and vascular bundle implantation into the lunate for Kienbock's disease, Herbert screw insertion though a minimal exposure for acute scaphoid fracture, and closing wedge oseotomy of the radial styloid for the early stage of the SLAC wrist. It is hoped that this monograph will be of benefit to surgeons interested in not only achieving more satisfactory clinical outcomes, but also in stimulating further contemplation and research about these difficult wrist problems.

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.

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.

Professor Philip Bromage From the earliest stirrings of modern surgical anesthesia, novice surgeons struggling to learn from the living what there was a strong intuitive feeling that anesthesia of part they were denied an opportunity to learn from the dead_ of the body would be better for the patient than complete But that is largely nostalgia for a past era_ Today, the visual anesthesia of the whole organism. In 1848, James Young arts and the plastics industry have united to give us superb Simpson spent some time and effort seeking this elusive teaching models and techniques that did not exist a few goal, but after a few ingenious though unsuccessful experi decades ago, and they have developed two- and three ments, he gave up the search and turned back to general dimensional surrogate cadavers that are imbued with a anesthesia as the only practical solution to surgical pain more vivid artistry than ever existed on the marble slabs relief at that time_ amid the formalin reek of our old dissecting rooms_ earl Koller's simple but brilliant application of cocaine to This book is a fresh and highly successful attempt to repair some of the bridges that were burnt with the passing of the the eye in 1884 opened the door to a whole new universe of neural anatomy and pharmacology_ Within a decade or old anatomy days_ Together, the authors have contributed"

In this new volume, Dr. Gregory Fanelli, of the Geisinger Medical Center and a reknowned expert on knee injuries, provides orthopaedic surgeons with an unprecedented review of the most recent and advanced knowledge needed to successfully diagnosis and treat PCL injuries. This comprehensive and practical volume covers everything from biomechanics and anatomy, evaluation and non-operative treatment to the latest surgical treatments of PCL injuries using arthroscopy, grafts and synthetic ligament substitutes. In addition, contributions from such well-known specialists as Drs. M. Malek, Roger Larson and Fred Flandery make this an essential text for every orthopaedic surgeon.

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.

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.

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."

This volume addresses the issues, complications and treatments that face hip specialists and general orthopaedic surgeons in both the surgical and non-surgical treatment of hip fractures. Over 500 photographs and drawings explain the various types of hip fractures. In addition, this book covers epidemiology and mechanisms of injury, diagnosis, treatment principles, rehabilitation, outcome assessment, and the economics of treatment and prevention. Hip Fractures provides complete coverage of the diagnostic and technical techniques making it the definitive source for decision making.

The subtitle of this book - A Holistic Approach to Rehabilitatio- underscores our fundamental point of view regarding spinal ailments. The patient with his ailments should be at the focus of attention, yet the subtitle combines two important elements, namely, "rehabilitation" and "holistic approach. " It is only by combining both concepts to show that they do belong together that the door to successful treatment of persons with vertebral problems can be opened. Holistic medicine does not require an ideological classification of its own, but should be under stood as a unified, optimal form of medicine which encompasses the whole person: his health and his illnesses in all their aspects. Too often, there is an automatic, senseless separation of the two concepts. Purists in one or the other camp need to recognize the common ground and to eliminate the barriers that have been erected by extreme positions and attacks. When we look back into history, we can see that there have always been schools of medical thought that have promulgated one or another direction. Evaluations and interpretations change in accordance with our knowledge and the times themselves, but that which is most valu able remains in end effect, forming the starting point for following gen erations. It should be noted that the entire body of medical knowledge had its beginnings in empiricism, whose ideas could not be confirmed and supported until much later, parallel with the developments in research technology."

Dr. MAQUET, the foremost disciple of Professor PAUWELS' and the orthopae dic heir to the PAUWELS' concepts of osteotomy of the hip for arthritis, has assembled in this one book the strongest and most lucid contemporary statement of the principles and practice of this very important school of hip surgery. Professor PAUWELS' contributions to the understanding of the biomechanics of the hip and to the concepts and execution of osteotomy of the hip for arthritis are outstanding and timeless. With clarity, Dr. MAQUET articulates this position and refines it further in the light of his own investiga tion. While other investigators, of course, differ on individual concepts or princi ples in this book or disagree with specific positions, assumptions, or conclu sions, it is clear to all that this book is a benchmark work. Dr. MAQUET, as Professor PAUWELS always did, illustrates his text lavishly with beautiful examples of individual cases illuminating the principles ad vanced. But in addition, he has gone further and presents long-term follow-up data, quantifying the results of these surgical precepts as experienced in his own practice. It is a work that has been long sought and is richly received. Boston, Massachusetts, 1984 WILLIAM H. HARRIS, M.D.

During their 20 years of activity members of the Associa tion for the Study of Internal Fixation (AO - ASIF) have made authoritative contributions to the development of internal and external fixation. The close collaboration of surgeons, basic researchers, metallurgists, engineers and the establishment of clinical documentation has made it possible to achieve a solid scientific basis for internal fixa tion. Clear definitions for the standardization of different types of osteosynthesis were possible: interfragmentary compression, splintage and buttressing as well as combina tions of these three techniques. At the same time a scienti fic and workmanlike instrumentation was developed. The idea was to keep diversification within limits but, however, to assemble a comprehensive collection of implants and in struments to answer all the problems presented by the com plexity of bone operations. Osteosynthesis is a difficult and demanding operative method. Its. claims on the surgeon and the theatre staff are high. Therefore plans have existed for a long time to supplement the "Manual of Internal Fixation" with a de tailed description of the AO Instrumentation, its use and maintenance. Our collaborator FRIDOLIN SEQUIN, graduate engineer, has accomplished this task with expert knowledge. He has organized over many years courses for theatre nurses and has been able from the resulting experience to provide helpful suggestions. When RIGMOR TEXHAMMAR R. N. joined AO-International four years ago, it was natural to include her as a co-author."

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."