This very comprehensive single-volume textbook was edited and written by
Dr. Morrey and six other section heads, all faculty members of the Mayo
Clinic. In all, seventy-six people wrote or contributed to individual
chapters. Dr. Morrey himself contributed to all but the hand and foot
sections.
With 1171 pages of text, this large book covers arthroplasty of some twelve
different joints—from the big toe, up the body, and down the arm to the
finger. In the dedication, Dr. Morrey states that over the course of
publication of the three editions of this textbook, the focus has become more
broad based and now includes more information regarding the general experience
from the literature. Yet, there is still a strong emphasis on "how we do
it at Mayo," which, in my opinion, is a strength.
For the most part, the chapters are relatively short, varying in length
from six to twenty pages. Some chapters are more general in nature, and some
deal with specific treatment problems. This method of organizing the text was
done for the sake of completeness and also for ease of reading. Throughout the
text, the many wonderful illustrations, consisting of sketches, full drawings,
and radiographs, clearly depict relative anatomy, biomechanics, surgical
approaches, techniques, results, and complications. In most chapters, the
anatomical graphics alone are enough to make the purchase of the book
worthwhile.
The book begins with the history of joint arthroplasty, bone cement, the
metallurgy of joint components, and the articulations of various materials in
the components. Short chapters are devoted to the various host problems and
complications. It then progresses to the clinical sections pertaining to the
hand and wrist, the elbow, the shoulder, the hip, the knee, and the foot and
ankle. There are simply too many subjects covered to discuss each one in
detail in this review. Suffice it to say that I cannot think of a single
aspect of joint arthroplasty that has not been covered well.
The information in this book will fill a variety of needs: it will serve as
a helpful source for an already knowledgeable surgeon who is treating a
specific patient or preparing a grand-rounds presentation, as an excellent
update on virtually every aspect of a specific problem that is likely to be
encountered by a joint replacement fellow, and as basic reading for residents.
To give a personal example of the book's usefulness, when I was confronted
with a woman who presented with bilateral 35° knee flexion contractures
and joint destruction from rheumatoid arthritis, I turned straight to the
chapter devoted to the management of deformities (Chapter 78) and read the
rationale for a step-by-step approach to a combination of bone resection and
capsular ligamentous releases along with component selection. The authors had
stated that there were barely any results on this subject in the literature,
so it was reassuring to read how this was handled at the Mayo Clinic.
That same type of helpful information can be found for the management of
other deformities and for all sorts of post-operative complications. The
authors have collated the literature, thereby saving a lot of time and perhaps
misdirected searching by the reader. A good example of this is the chapter on
extensor mechanism problems following total knee arthroplasty. It was stated
that, in the treatment of patellar fracture, knees treated with surgery had
poorer results than did knees treated without surgery and that the decision
regarding surgery must be individualized to the patient.
The section on the knee contains general discussions that beautifully
describe the anatomy and surgical approaches to the knee, followed by an
explanation of biomechanics as well as some basic considerations regarding the
implants themselves. Is it better to retain or to sacrifice the posterior
cruciate ligament? To cement or not to cement? What is the current status of
unicompartmental prostheses? What about the mobile bearing knee? What are the
basic considerations and precise techniques of revision? And, how does one
manage the infected knee? In most sections, the discussions are concluded with
"the author's preferred method."
The section on the hip is of a similar high caliber. Although a description
of how to perform a total hip replacement can be found in many publications,
this textbook offers much more. It covers the management of proximal femoral
deformity, developmental dysplasia, chronic dislocation, the acetabulum that
has been weakened by tumor or deformed by trauma, the pagetoid hip, and other
specific problems. Also included are lots of sketches and radiographs of
actual patients.
It is probably not possible that all experienced surgeons will agree with
all of the "authors' preferences." For instance, I was surprised
to see that resurfacing joint arthroplasty was recommended as a treatment for
some patients with carpometacarpal osteoarthritis at the base of the thumb.
However, the preferences are given only after a full presentation of the
alternative treatment methods, and, when appropriate, an admission of
uncertainty as to the long-term results of those treatments.
The latest techniques are described in general, an example being the distal
ulnar prosthesis designed by the Mayo wrist group. The author states that the
results obtained with the prosthesis are still preliminary and identifies the
potential drawbacks. The areas in which there are no "latest"
designs, just redesigns of suboptimal prostheses, are also mentioned. An
example of this is total wrist arthroplasty, in which the popular models of
twenty years ago have been abandoned by the manufacturers, the models of ten
years ago still have major failure rates secondary to loosening and imbalance,
and the latest designs may or may not answer the problem.
In summary, I can say enthusiastically that this book is a delight to own.
It belongs on the shelf of anyone who performs joint arthroplasty and
certainly of any practice group or orthopaedic department. A single person
could not possibly amass the amount of basic-science and clinical information
that is so nicely presented in this easy-to-read and easy-to-view textbook. It
is wonderful.