Issn Print: 0021-9355

Publication Date: 1997/08/01


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COMPLEX AND REVISION PROBLEMS IN SHOULDER SURGERY. Edited by Jon J. P. Warner, Joseph P. Iannotti, and Christian Gerber. Illustrated by William L. Filer. New York, Lippincott-Raven, 1997. $125.00, 422 pp.

William D. Stanish

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Excerpt

This textbook represents an attempt to enhance our understanding of pathological conditions related to the shoulder joint. The editors are renowned and respected in their home countries, and they have attempted to weld together the theories and techniques (in shoulder surgery) of North America, Europe, and the United Kingdom. To achieve an international flavor, they have offered two distinct introductions representing two continents—one from Charles Rockwood of San Antonio, Texas, and the other from Daniel Goutallier of Paris, France. To try to “assemble the wisdom of North American and European communities” is a noble quest, but the peril is that the reader can come away confused by the inconsistencies in philosophy, approach, and technique.
The book's title may be somewhat misleading. The concept of a well crafted text that emphasizes difficulties with revision operations involving the shoulder has distinct appeal. However, little space has been devoted to the harsh realities of such operations, including the very difficult predicaments encountered in total shoulder arthroplasty. Operative exposures, the hazards of exposing a scarred axillary nerve, and techniques of internal fixation (for instance, of a malunited fracture of the inferior aspect of the glenoid) are not addressed. In addition, the illustrations are not consistent from chapter to chapter, and this tends to detract from the over-all continuity of the text. The intraoperative photographs vary in quality and can be confusing, even when they are accompanied by adequate descriptions. The section on “Arthroscopic Repairs for Instability” would definitely have benefited from the inclusion of color photographs. On the other hand, a vast amount of information is presented, and in that sense this text makes an important contribution.
As in most multiauthored medical texts, the individual authors generally have no difficulty in describing their personal technique of choice; however, the reader must search deeply for hard scientific data in some of the material. For example, in the chapter on “Rotator Cuff Arthropathy,” it is suggested that one of the senior authors used four different techniques in a small cohort of eighteen patients. These patients then were evaluated after a brief two-year follow-up. Any attempt to perform an objective scientific analysis on such a small group of patients, with a number of confounding issues, is clinically unsound and renders the operative results more anecdotal than statistically significant. The personal observations of any senior orthopaedic surgeon are valuable, but they should not be offered as gospel or as the best solution to a particular problem.
There are several especially useful chapters, particularly the section on “Difficulties Related to Shoulder Arthrodesis.”
Several classic textbooks on the operative treatment of the shoulder already have been published. The works of Neer, Rockwood, Hawkins, and Matsen serve as yardsticks by which each subsequent contribution can be measured. The current text may fill a niche in the orthopaedic marketplace; however, one may want to evaluate it at the local medical bookstore before purchasing it for one's library shelf.
William D. Stanish, M.D., F.R.C.S.
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