The lofty title of this book is descriptive of the rapidly advancing state
of knowledge regarding the role of mechanics in our ever-expanding
understanding of the musculoskeletal system and its constituent materials. The
book has grown by three chapters and more than 200 pages since the second
edition, which was published in 1997. While several of the authors are new,
others have been maintained, and the text flourishes through their various
contributions. Although entire text-books have been devoted to the history of
science, the author of the first chapter of this textbook succinctly describes
the march of progress with specific regard to the appreciation of
biomechanical concepts. The evolving contributions of many individuals, from
ancient to modern times, are described in a way that compliments our
predecessors while acknowledging that they themselves stood on what Sir Isaac
Newton termed "the shoulders of giants."
This erudite introduction moves the reader gently into the succeeding
chapters, each starting with first principles and then progressing to subjects
of increasing complexity. Chapter 2, for example, is an extremely well-written
account of the basic principles of mechanics, starting from concepts of force
and moment equilibrium and progressing to the solution of indeterminate
problems involving the soft tissues of the skeletal system. This chapter is
readily followed by Chapter 3, which engages our understanding of the
kinematics and kinetics of locomotion with relevant clinical applications and
ends with a series of problems to challenge the reader. The thread continues
through a newly written chapter on the biomechanics of cortical and trabecular
bone.
Insight into the physiology of normal joint function as well as the
pathophysiology of degenerative joint disease depends on an understanding of
the mechanisms of load transmission across and through cartilaginous
structures. The composition, mechanical properties, and material behavior of
these structures are presented in three well-written chapters (Chapters 4, 5,
and 6) that together describe a chronological advance in our understanding of
such. Descriptions of the physical regulation of cartilage metabolism,
including chondrocyte response to different mechanical and electrical stimuli
as well as the influence of these at the molecular level, are also discussed.
The reader gains an appreciation of the terms "mechano-biology"
and "tissue engineering" within these chapters. Assigned problems
are again included to test our understanding.
Further chapters on joint lubrication and the contemporary imaging
technologies that are being used to describe the anatomy of diarthrodial
joints contribute to our appreciation of this unique biological system. A new,
comprehensive chapter focuses on contemporary biomaterials, ranging from
metals to emerging biological scaffolds. The only criticism of this chapter
would be that the authors did not inform the readers of the almost daily
advances that are being made with regard to articulating polymers. A highlight
of this text-book is the extremely well-written chapter on the biomechanics of
fracture fixation and fracture-healing concepts, which was produced through
the collaboration of a well-informed engineer and a clinician. The remainder
of the textbook is comprised of original-author chapters repeated from the
second edition. One of these chapters includes a comprehensive background on
the preclinical testing of hip joint replacements through both computational
and physical evaluation. That chapter is accompanied by an appreciable
appendix on the principles of solid mechanics and their application. The last
chapter offers a contemporary focus on the continual evolution of knee design
and discusses the simulators that are being used to evaluate the anticipated
in vivo performance of knee prostheses.
As a parenthetic note, all fifteen chapters are written by first authors
with PhDs, with but two clinicians as secondary authors. The growing
complexity of our expanding knowledge base in this field has broadened the gap
between the clinical practice of orthopaedic surgery and the laboratory
advances that enhance basic understanding. It is becoming increasingly obvious
that no single individual will grasp the totality of this discipline. This
observation is perhaps best illustrated in the time line contained in Chapter
7, which highlights the increasing need for individualized collaboration
between disciplines and lists seamless interaction as its end point.
In summary, within the extensive pages of this discourse, the reader will
find a current, comprehensive body of information that will aid our
understanding of the role of biomechanics in normal and diseased states of the
musculoskeletal system. This book will find a welcome place in orthopaedic,
life-science, and engineering libraries.