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The Arthrodesis in the Restoration of Working Ability. Edited by George Chapchal. Acton Massachusetts Publishing Sciences Group Inc 1975. 233 pages

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the knee, hemophilia, and juvenile rheumatoid arthritis.
The remainder of the book is devoted to topics of orthopedic interest that are not directly related to arthritis.
Before making a few specific comments, 1 will
describe the book in general. It is one of a series of
volumes that have been published at intervals since
1964. Each volume is devoted to a few selected topics.
The editor chooses his experts who, in turn, approach
the topics from various points of view. A contributor
may dwell on new developments as adopted in his own
current practice. He may present a status report of practice techniques, most of them tried and true, or
summarize a disease or condition in which, apart from
the orthopedic problems, systemic manifestations and
pathology properly belong to a specialty other than
The three chapters that would interest a rheumatologist fit the above tripartite scheme nicely. First,
total arthroplasty of the knee, the current frontier of
orthopedic surgery, is dealt with in a series of four
subchapters on different models of devices being used; a
discussion of several additional models follows. The
emphasis is on the devices being developed. A chapter
on hemophiliac patients, who often offer the orthopedic
surgeon challenges in rehabilitation, describes those
newer developments in the replacement of clotting factors that provide greater opportunities for orthopedic
surgery. The surgery is standard, but mostly previously
impractical because of now avoidable bleeding problems. The chapter on juvenile rheumatoid arthritis is a
short summary of the disease as the pediatrician sees it,
of the conservative therapy given by the orthopedist in
children, and of the long-term sequelae amenable to
orthopedic treatment in the adult.
Of the three chapters, the one on total knee arthroplasty seems to be the most valuable for obvious
reasons: Knee problems are so frequent in arthritis
patients, and arthroplasty is in such a dynamic state of
development, that nearly everyone should be interested
in a report of the current state of the art.
Although all the experts provide extensive technical discussions of the engineering of the devices, manner
of application, and advantaBes over other devices, the
rather summary descriptions of in-service performance
reflect the relatively short (5-year) developmental history. Relatively few cases are described by the authors,
and all of them are from large medical centers where the
procedures have been developed. In each article about
100-200 cases are mentioned; for comparison, the same
centers could easily have reported 1000 cases of total
arthroplasty of the hip. Obviously total knee arthropArthritis and Rheumatism, Vol. 19, No. 3 (May-June 1976)
lasty is not a routine operation and, if the experts
are reluctant to widen its application, the technique
must not be ready for even occasional use. Perhaps
the reasons for this reluctance are that the indications
are not yet clearly delineated, that the complications
are too frequent, and that the proximity of the prosthesis
to the skin and sensitivity of the knee to minor malalignment present too great a danger. These subjects
are not discussed, but they may not be relevant to the
purposes of the book.
Whether the book can be recommended to an
audience wider than practicing orthopedic surgeons is
questionable. Certainly it is a good account of current
practice, with the reservations mentioned. And certainly
it gives summaries of developments by experts who are
relieved of the constraints of documentation demanded
in articles in medical journals. Finally it has the great
virtues of easy readability, up-to-date references, and
Kennedy Memorial Hospital for Children
30 Warren Street
Brighton, Massachusetts 02135
The Arthrodesis in the Restoration of Working
Ability. Edited by George Chapchal. Acton,
Massachusetts, Publishing Sciences Group, Inc,
1975. 233 Pages.
This compact volume contains over a hundred
short contributions by a variety of continental authors,
all focused on the subject of arthrodesis of major and
minor joints. In general the subjects are well defined
from the standpoints of indications, biomechanical effects, and techniques, including some recent additions
using A.S.I.F. instrumentation. All joints of the upper
and lower extremities are covered, with special attention
to the hip and knee, and there is a particularly thorough
exposition of problems of arthrodesis of the spine. Because the conference on which this book is based was
as least in part directed toward rehabilitation of the
injured working man, considerable attention is paid to
restoration of employability and functional use of the
extremities for the purposes of insurance evaluation.
Parts of the book are highly technical with many details
provided for operative procedures. There are some end
result studies included, and although some of the chapters include a number of references, many do not.
Arthrodesis of the extremities is not a common
orthopedic pr,ocedure in the United States today; many
of the procedures described are rarely if ever performed
in this country, except in very specialized centers. The
details of the operative procedures are of some interest,
and as such, certain chapters would be of some value as
a manual for the reconstructive orthopedist or for someone who deals with late effects of trauma. There are too
few end result evaluations to judge the quality of some
of the operative procedures described. The information
related to workmen’s compensation is of value to industrial surgeons.
Although the book does not have widespread
appeal, it may prove a valuable addition to orthopedic
libraries, particularly those in centers that deal with a
large volume of reconstructive industrial orthopedics.
The book is generally well illustrated and the translation
from the original language is for the most part quite
Chiex Orthopaedic Service
Massachusetts General Hospital
Boston, Massachusetts 021 14
Rheumatology. An Annual Review. Vol. 6. Immunological Aspects of Rheumatoid Arthritis.
J. Rotstein (coordinating editor); J . Clot and J .
Sany (volume editors). Basel, S Karger A G ,
1975.368 Pages, 86 illustrations. Price: $61 S O .
This volume represents the reports of the International Symposium on Immunological Aspects of
Rheumatoid Arthritis, which was held in Montpellier,
France, in March 1974. The meeting was sponsored by
the Socittt franqaise de Rhumatologie and the Institut
national de la Santk et de la Recherche mtdicale. The
book, published as an Annual Review of Rheumatology,
not only reflects the thinking of senior investigators in a
variety of areas, but also serves as a vehicle for the
Arthritis and Rheumatism, Vol. 19, No. 3 (May-June 1976)
factual updating and collating of opinions in the area of
immunologic aspects of rheumatoid arthritis. Although
all of the presentations are not of equal quality, by and
large the volume is outstanding. The presentations are
succinct and the discussions give a good perspective of
the field.
A variety of topics on rheumatoid disease are
discussed, including immune complexes, complement, T
and B cells, experimental models, and infectious agents.
That a book of only 368 pages embraces such a broad
scope of topics clearly suggests that much material is
touched only superficially. Nevertheless the summary of
each paper and the authoritativeness with which each
topic is approached add much and make the book a
worthwhile addition to the library of any rheumatologist or clinical immunologist.
The University of Alabama
in Birmingham
University Station
Birmingham, Alabama 35294
Disorders of Connective Tissue. Daniel Bergsma, Editor.
Stratton Intercontinental Medical Book Corporation,
381 Park Avenue, New York, N . Y . 379 pages. Price:
Rheumatologie fur die Praxis. H . J . Albrecht. S. Karger
AG, Arnold Bocklin Strasse 25, CH-4011 Basel, Switzerland. 284 pages. Price: approximately $1 9.00.
Surgical Management of Degenerative Arthritis of the
Lower Limb. Richard L. Cruess and Nelson S. Mitchell.
Lea & Febiger, 600 Washington Square, Philadelphia,
Pa. 236 pages. Price: $22.00.
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