Vincent J. Vigorita, with Bernard Ghelman and Douglas Mintz. Philadelphia: Lippincott Williams and Wilkins; 2008. 808 pages. $299.00. ISBN: 978-0-7817-9670-5.
In the nine years since the first edition of this volume, there has been an explosive growth in the knowledge of cell-signaling mechanisms in bone development, growth, and repair. Seemingly little time goes by without the description of some hitherto unsuspected autocrine or paracrine relationship between bone cells that influences both the normal state and various disease states. Perhaps the sheer difficulty of keeping up with these rapid advancements has slowed the proliferation of textbooks on bone pathology. Consequently, while the first edition of this book was an ambitious undertaking, its revision to conform to the state of knowledge in 2008 must have been daunting.
It is obvious from both editions of this work that the author has a very broad experience in bone and joint pathology, is able to approach the subject in a logical and straightforward manner, and is a great teacher. The subjects are handled in easy to digest steps, starting with a chapter on the basic science of bone and then proceeding with chapters on calcification and ossification syndromes, metabolic bone diseases, infections, tumors and tumor-like lesions, and joint lesions, with separate chapters allotted to periosteal alterations and osteonecrosis.
While much of the content is similar to that of the first edition, there have been very notable updates when necessary, and this is especially apparent in the chapter on basic science. Given all of the changes now known about ossification and osteoblast-osteoclast signaling interactions, it is not surprising that the format and contents have changed appreciably. Remarkably, Dr. Vigorita has emphasized the cell interactions that are most relevant to the histopathologic and clinical problems in bone disease. This, in turn, makes the text easier to digest by orthopaedic surgeons and pathologists alike. The changes have necessitated some reorganization of material so that the basic science of cartilage is now in the chapter on arthritis; this makes perfect sense in the new context.
As in the first edition, the rare photographs make the text more meaningful, and the addition of even more pictures and great artwork has clarified this second edition even further. The manner in which clinical, imaging, and pathologic illustrations are used not only makes pathology relevant for orthopaedic surgeons and clinically useful for pathologists but also serves to emphasize the need for close cross-disciplinary cooperation between surgeons, radiologists, and pathologists so that the best diagnoses and treatments may be rendered.
The appendices, which serve to summarize and demystify the various ancillary techniques that are used in laboratories, have been increased from six to seven with the addition of bone-banking. The illustrated glossary, which remains essentially the same as in the last edition, is still a very useful feature. The very minor typographical errors in the last edition of this book have been addressed and corrected. A few of the illustrations of histologic slides in this edition would still be better served with more detailed figure legends. While this may not matter for practicing pathologists, clearer explanations would better serve orthopaedic surgeons and trainees in orthopaedic surgery, radiology, and pathology.
Finally, the publisher of this edition has attempted to bring this work into the digital age by supplying the book with its own proprietary web site. While one can access the full text and all illustrations on this site, it is usually easier to do this by conventional reading. However, the potentially unique feature of the web site will be the ability to generate quizzes, which are especially useful in assessing one's competency for specialty certification board examinations. To my great disappointment, this feature was not yet available as of this review.
In short, the second edition of this book is an improvement on the first version. Its ambitious scope, easy readability, organization of relevant recent bone bioscience, and unique illustrations make the reading of this book a must for anyone interested in the diagnosis and treatment of bone diseases.