Basic Orthopaedic Biomechanics

Abstract

Basic Orthopaedic Biomechanics, 2nd Edition, Van C. Mow and Wilson C. Hayes (Eds.), (ISBN 0-397-51684-3, Lippincott-Raven Publishers, 12105 Insurance Way, Hagerstown, Maryland, 21740-5181), 544 pp., $89.00. The second edition of Basic Orthopaedic Biomechanics demonstrates the extent to which biology and engineering have been integrated in contemporary orthopaedic biomechanics. The text is a pandect of the interdisciplinary approaches through which orthopaedic biomechanics research is conducted. Perusing the Table of Contents, I was impressed with the list of contributors. It resembles a Who's Who in Biomechanics, boasting four past presidents of the American Society of Biomechanics and four recipients of the Borelli Award, the highest recognition for achievement given by the American Society of Biomechanics. The text presents orthopaedic biomechanics as a continuum, one in which the distinctions between biological and mechanical mechanisms may become arbitrary. This integration of human movement sciences, engineering disciplines, and molecular and cellular biology has given rise to the scientific and clinical advances that could not have otherwise been achieved. The continuum is highlighted by those pathways between a simple ground reaction measured during locomotion, hard and soft tissue deformation, and ultimately, the perception and response by individual cells to their physical environment. The manner in which mechanical stimuli are transduced across cell membranes and the means by which this process is linked to phenotype expression represents some of the most cutting edge work in the area of orthopaedic biomechanics. This work is crucial to the emerging area of tissue engineering and the continually evolving areas of fracture fixation and implant design. The 12 stand-alone chapters are a balanced mix of biomechanics at the organism and tissue levels, biomechanics of hip and knee prosthesis design, fracture fixation, and quantitative imaging. The organism level biomechanics includes analysis of muscle forces and joint loads, applications of clinical gait analysis, and biomechanics of the spine. The basic science chapters present the biomechanics and biology of bone, tendon, ligament, cartilage, and meniscus. Each basic science chapter presents the relevant engineering and biological concepts as they relate to the particular tissue and the physical behaviors of the tissues. In some cases, although this has led to a degree of some redundancy, it is not undesirable given the relative independence of each chapter from the others. Each chapter is well referenced and several chapters include example exercises and problems and their solutions. Several chapters include sections related to tissue biomechanics and the influences of exercise and aging. The second edition includes new chapters that present topics that have been seminal in orthopaedic biomechanics and, in some cases, orthopaedic practice. The chapter on physical regulation of cartilage metabolism is a clear and concise review of the work that has characterized the influence of physical factors, from abnormal joint loading patterns to electric field effects within the exrtracellular matrix, on chondrocyte activity. A great deal of this work has emerged only over the past decade. The chapter on quantitative anatomy of diarthrodial joint articular layers provides an overview of visualization methods and geometric modeling tools from which the 3D geometry of articular layers may be developed. In conjunction with the newly added chapter on the biomechanical principles of total knee replacement design and the revised chapter on the biomechanics of artificial hip joints, an important facet of the technological and design elements of orthopaedic science has been nicely encapsulated. Given the rapid pace of orthopaedic-related scientific and clinical discovery, it is likely that a third edition of this text will become appropriate. That would be an excellent opportunity for the editors to consider the inclusion of a separate chapter on the biomechanics of skeletal muscle. It is mildly surprising that skeletal muscle has not been awarded this stamp of importance. The inclusion of such a chapter on skeletal muscle in a text on orthopaedic biomechanics seems more than fitting. The richness and complexity of the biology and mechanics of skeletal muscle and the integral role of skeletal muscle on the homeostasis of each of the tissues presented in the text seem to argue in favor of its inclusion. The book has been targeted toward senior engineering students interested in orthopaedic biomechanics and engineer-trained orthopaedic residents interested in pursuing biomechanics research. However, it may rightfully find a home on the shelves of personal and/or laboratory libraries of those desiring an excellent reference to contemporary orthopaedic biomechanics. This certainly includes, for example, those exercise scientists, physical therapists, and occupational therapists for whom understanding the biological implications of mechanical loads on tissues is important. Reviewed by: Mark D. Grabiner The Cleveland Clinic Foundation, Cleveland, OH