At a time when an increasing number of total knee arthroplasties are being performed, other operative strategies, such as tibial osteotomy and unicompartmental knee arthroplasty, are being used sparingly. Paradoxically, orthopaedic surgeons who treat problems related to the knee are embracing the concept of minimally invasive operative treatment. A less extensive operative exposure, with less resection of bone and with retention of ligamentous struts, has distinct appeal.
The authors do not attempt to coerce the reader or to promote the value of unicompartmental knee arthroplasty; rather, through thoughtful biomechanical and kinematic analyses, they attempt to answer the question of why this procedure has failed in the past. Sound biomechanical explanations are given as to why this procedure should have a place in the armamentarium of the orthopaedic surgeon who treats gonarthrosis.
The text flows well. Although it is multiauthored, the homogeneity of the articles and illustrations provides distinct continuity. The initial sections deal with the basic science of the knee, including gait analysis pertaining to both unicompartmental arthroplasty and total knee replacement. There is also a chapter on the biomechanical properties of materials that are generally used for arthroplasties.
At times, the book resembles an instructional manual on how to perform a proper unicompartmental arthroplasty. The discussion of the preoperative selection of patients merges nicely with those of intraoperative pitfalls and technical considerations.
An additional accolade is that the monograph cites at least fifteen clinical follow-up trials of patients who have had a unicompartmental arthroplasty. The reader is able to analyze critically the intermediate and long-term results of these studies, which are summarized in a table that provides rates of success and failure for each type of component used at the various centers.
Each of the four coauthors offers a quick prëcis as to the indications and contraindications for unicompartmental arthroplasty. These checklists will help the orthopaedic surgeon to decide whether to perform an osteotomy, a unicompartmental arthroplasty, or a total knee replacement.
This monograph will be of interest to orthopaedic surgeons who are familiar with and accept unicompartmental knee arthroplasty, and it will be enlightening for skeptics in that many of the shortcomings of this type of operative intervention are addressed. The text cannot be read easily, and the reader is unlikely to place it on a bedside table. However, it is well organized, uniform in its presentation from chapter to chapter, and honest in its suggestions with regard to when this technique can be used most effectively.
William D. Stanish, M.D., F.R.C.S.(C)
Deputy Editor for Sports Medicine and Arthroscopy
The Journal of Bone and Joint Surgery
Needham, Massachusetts