Mechanics of Human Joints: Physiology: Pathophysiology, and Treatment PDF
Preview Mechanics of Human Joints: Physiology: Pathophysiology, and Treatment
VERVNEAR NWAR IGWHRTIG HT VERVNEAR NWAR IGWHRTIG HT VERVNEAR NWAR IGWHRTIG HT VERNA VERNA WRIGHT VERNA WRIGHT VERNA WRIGHT VERNA WRIGHT VERNA WRIGHT VERNA WRIGHT VERVNEAR VNWEARR VINGWEAHRR TINWG ARH ITGW HRTIG HT VERVNEAR VNWEARR VINGWEAHRR TINWG ARH ITGW HRTIG HT VVEERRVNVNEAEAR R VNWNWVEAARRRE IRVINGWGWVNEAHHRRREA TITRIN WG G NWAHRHA TRITG W I GWHRHTRIG TIGH HT T VERVNEAR NWVARE IRGWVNHREATIR G NWHATR IGWHRTIG HT VERVVNEEARR VNNWEAVARR E INWRGWAVNRHR EAITIGWR G HNWRHTAITRG IHGWTHR TIG HT VERVNEAR NWAR IGWHRTIG HT VERVNEAR NWOAR IFGWHR TIG HT VERNA VERNA VERNA VERNA VERNA VERNA VVVVEEEERRRRNNNNAAAA VV VEEEVVVVRRREEEENNNRRRRAAANNNN AAAA VERNA VEVRENRAN A VERNA VEVRENRAN A VVEERRNNAA VVEEVRVRENENRARAN N AA VVVEEERRRNNNAVAVA E E RVRNENVVVARAEEE N RRRANNN AAA VERNAV ERNVAE RNA VERNAV ERNVAE RNA PHYSIOLOGY, PATHOPHYSIOLOGY, AND TREATMENT EDITED IY VERNA WRIGHT ERIC L. RADIN University of Leeds Henry Ford Hospital Leeds, England Detroit, Michigan 0 CRC Press c~ Taylor & Francis Group Boca Ratan London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 1993 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works This book contains information obtained from authentic and highly regarded sources. Reason- able efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www. copyright.com (http://www.copyright.coml) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organiza- tion that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRe Press Web site at http://www.crcpress.com Foreword Mechanics is the basic science of orthopedics; orthopaedic surgery could be defined as that branch of medicine in which the principles of engineering sci- ence and biology are employed in the understanding and treatment of disorders of the locomotor system. Of course, orthopedists also need to deploy several other wisdoms. All surgeons, whatever their specialty, must be applied zoolo- gists and have an understanding of the sciences upon which physiology and pathology are based. But, it is the peculiar and particular responsibility of those who treat musculoskeletal disorders to grasp the mechanical principles involved and appreciate the engineering consequences of surgical intervention. It is perhaps odd that such assertions still need to be made. It is difficult to imagine, for instance, an ophthalmic surgeon who was ignorant of the science of optics and yet, in the latter part of the twentieth century, with all the achievements of joint replacement and fracture fixation behind us, there are still orthopedic surgeons who can hardly distinguish a stress from a strain. Human joints are immensely sophisticated, having been developed to resolve the tremendous and often conflicting demands of competitive evolution. Such structures do not give up their secrets easily and the perceptive reader of this book will soon appreciate that there is very much yet to be learned. Animal articulations so far exceed their man-made counterparts in economy and relia- bility that comparison with the products of the factory and the workshop are often as misleading as they are useful. Nevertheless, there is no chance of iii iv Foreword understanding them at all except in terms of the classical theories of mechan- ics, which are here presented as they relate to the pathophysiology of human joints. John Goodfellow Consultant Surgeon Nuffield Orthopaedic Centre Oxford, England Preface Synovial joints are beautifully engineered bearings, a remarkable tribute to their designer. Their coefficient of friction is amazingly low, their anatomy subserves function superbly, and the muscles that control their movement are equally breathtaking. Yet these structures do fail, and disease results. To understand these disasters, the physiology of joints needs to be understood, and the mechanics of the composite and individual structures (overall design, cartilage, synovial fluid, ligaments, nervous tissue, and muscles) studied. The interrelationships of these in terms of lubrication regimes, gait patterns, and stiffness require study. Only then can a clearer understanding of problems, such as osteoarthrosis, spondylosis, and the pathologic effects of vibration, be obtained. This will lead to physiologically based treatments, including the proper design of joint replacements. Moreover, those who consider inflam- matory polyarthritis purely in terms of immunology and molecular biology would do well to ask themselves why different joints are preferentially attacked and why one part of a joint may be destroyed while the other is rela- tively spared. The phenomena may well have a biomechanical basis. To tackle these issues, a multinational, multidisciplinary team of authors, including anatomists, bioengineers, biologists, orthopedic surgeons, and physi- cians, has written this volume. Anyone interested in normal or diseased joints (physicians, orthopedic surgeons, rehabilitationists, and fundamental scientists) v vi Preface will learn from these chapters, and we hope be stimulated to develop the sub- ject further both clinically and physiologically. Verna Wright Eric L. Radin Contents Foreword John Goodfellow iii Preface v Contributors ix Part 1: Physiology of Joints 1. Biology of Joints 3 Peter A. Simkin Part II: Mechanics 2. The Anatomy of Joints Related to Function 27 Laurence M. Adams 3. The Mechanics of Gait 83 Jacquelin Perry 4. Synovial Fluid 109 Pie"e Geborek and Frank A. Wo/lheim vii
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