Pathology of Bone and Joint Disorders With Clinical and Radiographic Correlation Second Edition Edward F. McCarthy, M.D. Pres io Oop ag Te gis to Mee aro, 154 Frank J. Frassica, M.D. Pas ge ky Teese i, 4 &E CAMBRIDGE u UNIVERSITY PRESSany BIBUOTECA Centnar ous ACS seater 7) NUWi ADO CAMBRIDGE UNIVERSITY PRESS University Printing House, Cambridge CB2 8BS, United Kingdom ‘Cambridge Univesity Press is part of the University of Cambridge. 1k furthers the University’s mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence. wevecambridgeorg. Information on this tile: www.cambridge org/9781 107041233 © Faward ¥. Mc: thy and Frank J. Frassica 2015 ‘This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the writen permission of Cembridge University Press First edition published 1998 Second edition published 2015 Printed in Spain by Grafos $A, Arte sobre papel A catalog record for this publication is available from the British Library Library of Congrss Cataloging in-Pubiation Data McCarthy, Edward F., 1914- author. Pathology of bone and joint disorders with clinical and radiographic correlation ( Edward F. McCarthy, Frank). Frassic.- Second edition. poscm. Includes bibliographical references and index. ISBN 978-1-10704123-3 (Mined Medis) 1. Frasca, Franc]. author. Il. Til [DNIM: 1. Bone Diseases-pathology. 2. Joint Diseases putology. WE225] Ros 6167107-de23 2014014332 ISBN 978.1-107-04123-3 (Mixed Media) ISBN 978-1-107-08039-3 (Hardback) ISBN 978-1-139-94624-7 (Cambridge Books Online) Cambridge University Press has no responsibility forthe persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites i, or will main, accurate or appropriate Every effort has been made in prepating this book fo provide acurate and up-to-date information which is in accord with accepted stan. ards and practice atthe tine of publication. Although case histories ae drawn from actual cases, evry effort ha been made to disguise the identities of he individuals involved. Nevertheless, the authors, editors and publishers ean make no warranties thatthe information contained herein i totally fee from error, not least because clinical standards ae coastal changing through research and regulation The authors, ediors and publishers therefore disclaim all bility for direct or consequential damages resulting from the use of material contained in this book. Readers are stcongly advised to pay careful attention to information provided by the mansfactarer of any drugs or equipment that they plan tous.762365 To our mentors: Howard Dorfman and Frank SimContents Acknowledgments viii Proface: boundary crossings ix 1. Diagnosing bone disease 1 ‘Anatomy and physiology of bone 24 3. Genetic diseases of bones and joints 46 Metabolic bone diseases 70 5. The pathophysiology of fractures 101 6. Skeletal manifestations of systemic disease 114 7. Osteonecrosis 130 8 Infections of bones and joints 147 % Paget's disease 160 10, Metastatic carcinoma in bone 169 11, Plasma cell dyserasia 178 12, 13 4 16 v. 18 Primary bone tumors 187 Bone cysts 275, Tumor-like lesions 286 Diseases of synovial membrane 303 Diseases of joints 313, ‘The pathology of failed total joint arthroplasty 345 ‘Management of orthopedic pathology specimens from the operating room to microscope 356 Index 362viii Acknowledgments Many people have supported us during the writing of this book. Lucille McCarthy read the entire manuscript and helped us make it “reader friendly.” She also supplied encouragement ‘when the authors’ spirits were low, Norman Barker took many of the photomicrographs, and he and his staff worked with all of the photos to make sure they were instructive. Tim Phelps, fcom the Johns Hopkins Department of Art as Applied to “Medicine, did many drawings. We owe them thanks for their sill and patience Special thanks go to James Hawkins III who, with tireless devotion, typed many versions of the manuscript and managed the more than 1200 references. Without him this book could, not have been written.eee ette are eae ere aeiee Preface: boundary crossings ‘This book is an introduction to orthopedic pathology co-written by a bone pathologist and an orthopedic surgeon, It is based on our day-to-day collaboration at The Johns Hopkins Hospital. Not only do we work together in clinical medicine, we also teach together, and, in composing this book, we draw from both our daily practice and our in-service course in bone pathology. We instruct residents in pathology and orthopedic surgery, and it is for these students this book is primarily intended. In addition, however, we believe it provides practicing physicians ‘with useful survey of bone and joint disease. Although we keep our discussions at an introductory level, we supply appropriate references for those readers who want to inquire further. In our view, the information in this volume repre sents the minimum that residents in pathology and ortho- pedic surgery should know by the completion of their training. ‘Our underlying assumption throughout is that bone and. joint diseases are best viewed from multiple angles. Diagnos- ing skeletal disorders requires the close interaction of path- ‘ologists, orthopedists, and radiologists. Therefore, we ‘emphasize the correlation of pathologic features with clinical history and radiographic images. We believe this multi- disciplinary approach should inform students’ learning from. the beginning, That is, when pathologists begin to learn about bone diseases, they should, at the same time, learn to read radiographs. The radiographs represent the gross pathology ‘of bone and joint disease, and they provide the context for interpreting the histologic features. Conversely, orthopedists, and radiologists must learn to look at pathology slides. Seeing tissues under the microscope will help them better under- stand what a disease is doing to the patient. In sum, working with bones requires physicians to cross boundaries between specialties. When pathologists cross into the realm of images and learn to converse with radiologists, they return home with a better understanding of their own discipline. And when orthopedists speak with pathologists, they see their patients ina new light. These boundary crossings ‘may be likened to the enriched comprehension of English which results from studying French. This maltidisciplinary approach is what we practice and teach, and it is what we encourage in this book. ‘We organize this volume into 18 chapters, and they are best read in order, from fist to last. We begin, in Chapter 1, with, an overview of skeletal diseases and the principles of their diagnosis. In Chapter 2, we leave this general picture to begin building the foundational vocabulary needed to study bone disorders. That is, we summarize the anatomy and physiology ‘of normal bone, subjects required to understand abnormal bone. In subsequent chapters we explore each of the major bone disease categories we outline in Chapter 1: genetic, meta bolic, traumatic, infectious, circulatory, and neoplastic. In addition to bone disease, we also discuss joint diseases and the pathology of failed total joint arthroplasty, including metal-on-metal hip prostheses. To this second edition, we have added discussions of molecular genetics of many orthopedi diseases and new imaging modalities such as PET scan. In most chapters, we provide historical background of the diseases we describe, detailing archeological evidence of skel- tal disorders and honoring individuals whose work has led to ‘our current knowledge. This isto remind us that, in the words, of Sir Isaac Newton, “We stand on the shoulders of giants.” It also helps us remember that humans have suffered from these diseases for thousands of yeas.