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Modern Trends in THA Bearings: Material and Clinical Performance

Edited by Justin P. Cobb pp. 253 Berlin: Springer-Verlag, 2010 ISBN: 978-3-642-13988-8

The title of this new book led me to expect a critical review of the clinical and technical performance of the new 'hard bearings', now fashionable for total hip arthroplasty. This has certainly been provided here for metal-on-metal, metal-on-polyethylene and ceramic-on-ceramic articulations in a series of more than 30 separate papers contributed by experienced hip surgeons from around the world. What is less obvious is a linking theme between them to help the reader find a pathway to a logical conclusion through the mass of clinical and technical data.

I therefore turned to the Editor's Preface for guidance. Professor Cobb has provided an overview as a decision-making aid for the orthopaedic surgeon faced with an ever-widening range of bearing couples and materials from which to choose. In addition he provides the data to assist in decision-making by managers, health economists and interested patients; although I doubt that many would have the necessary background knowledge or inclination to read it.

The individual contributions are well-chosen and very well-matched in their presentation and referencing, with good illustrations reproduced to the customary high standards of the publishing house. What is less helpful is the somewhat idiosyncratic grouping of the topics. It begins appropriately with general considerations; identifying the anatomical and pathological variations, and the lessons learned to date with the combinations of materials used to treat them. Having focused on the need for bearings with lower rates of wear, I had expected a sequence of papers for each material reporting the tribological and clinical results to date. That information is available, but interspersed with unrelated contributions on the imaging of failed hips, wear testing of intervertebral disc prostheses and the early clinical results of ceramic knee prostheses.

There is a wealth of information available for the selective reader and a large number of contributions deals with all aspects of the ceramic-on-ceramic hip replacement, including the causes of the 'squeaking hip'. Despite this worrying complication for patients, ceramics emerge on balance as the bearing couple of choice. The book will certainly appeal to the more scientifically orientated hip surgeon, but is not one for the average trainee to read from cover to cover.

D. L. Hamblen

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