This compilation of 79 papers is primarily directed at a clinical audience that wishes to understand the current status of computer-aided orthopedic surgery. The editors are practicing orthopedic surgeons and medical doctors from the US and Germany. In his foreword, Kenneth A. Krakow acknowledges that orthopedic surgery is “just a few moments past the sunrise” of its computer implementation, and that progress will be constrained by the clinical and technical challenges that have to be met, and the cost containment culture of global healthcare.

Primarily, the book captures the experience of those in the clinical world with the maturing technologies of surgical planning, navigation, and robotics in musculoskeletal surgery and reconstructive work. While the content is international, almost 100 of the 160 contributors are from Germany. The book is of high quality, with many striking color images. As with all compilations, it is largely up to the reader to structure the content; this is, however, assisted by a comprehensive index.

The papers are organized into sections; reviewing the papers in the sections shows the relative emphasis and maturity of each of the fields. Almost 40 of the papers are on navigation (guiding the surgeon in tool and implant placement), and 36 are on knee surgery and navigation, including total knee arthroplasty (TKA) and anterior cruciate ligament (ACL) reconstruction. The emphasis on navigation reflects its importance as a key process in less invasive surgery for total joint replacement. The largest section on robotics is within the discussion of total hip arthroscopy, and is primarily associated with the preparation of the site for the prosthetic and the prosthetic itself. There is a small amount of material on spinal surgery, most of it focusing on navigation for the placement of pedicle screws, to avoid damage to the spinal column. The two closing sections are visions of the future by surgeons (focusing on navigation, navigation for the Asian knee, and medical robotic!s) and by those in industry (six perspectives). The visions of the future from those in industry are very commercially focused, and perhaps disappointing. The view of the future could have been strengthened by material from some key engineering and computing academics.

Given its focus on clinical practice, the key papers in the book are those presenting the current status and results of clinical trials evaluating commercial and experimental systems. While some of the results are preliminary or promotional in nature, a number of the most important papers include well-presented results of large and long-standing clinical trials, for instance, those on navigation and mini-incision total hip replacement by DiGiola et al., and on TKA navigation systems, by Clemens et al., Perlik et al., Ritschl et al., and Sparmann and Wolke. Other highlights are the paper on the application of Caspar to ACL replacement, by Gotzen et al., and a number of papers on the application of Robodoc to total hip arthroscopy.

Many of the papers in the compilation make contributions to the increasing body of evidence that computer-assisted surgery makes a statistically significant difference in improved outcomes, particularly via improved control of orientation and the fit of implants. The papers, however, identify that these improvements in outcomes may be associated with increased time in surgery. This highlights the need to capture and understand the benefits of these improvements in the context of reimbursement systems worldwide, and the need to create more operationally effective approaches.