Dominique had a Lyons formation and especially inhabitant of Saint-Etienne marked by the strong personality of his Master Gilles . At the time of a stay of study in the USA, it meets Charles S. and converts with the shoulder surgery. It successfully creates the “Center of the Shoulder” with Saint Etienne then thereafter settles in Paris. It informs us of his passion for the surgery and its traditional and rigorous vision of the trade.

 

. : Mr , of which area are you?

. : I was born in on the Seine, but in fact I am pure produced Lyons School where I made all my studies, the day school, the boarding school, and the . I was appointed with the contest of boarding school of Lyon in 1975 and I practically made all my boarding school in csotcina.comedy. I did much knee surgery and the hip at Henri and Georges De , in Jacques in Renee in and finally at Gilles in Saint-Etienne. I thus had primarily a formation of prosthetic surgery of the knee and hip and of surgery of the knee. I supported my thesis in 1981 and then I was appointed Senior registrar at during two years because there was no post of free at . Georges De was an astonishing character. He had a property at the Puy-en-Velay and he was going to seek his bread rod at the village with horse from where its nickname of “sheriff”. It was a strapping man who measured eters and which gave the impression to be a cow-boy but it was a charming type.

. : Did he die while operating?

. : Yes, it is true, it died of a stroke, practically while operating. I have a two years good memory spent to the Pavillon T, at where I operated many hips. However, my six-month period of intern at Gilles had marked me much and it had allured me by its ideas. When he proposed to me a post of head of Private clinic in 1983, I did not hesitate and I left to Saint-Etienne, with woman and children, without awaiting my post at Henri . I had already made two years of at but that was not enough for me because I wanted to make a university career. In short, when Gilles proposed a post of head of Private clinic to you, at his place, you combine there because this man had such a charm that gave desire for working with him.

. : Didn't that should have been taste of ?

. : It is true that in this Lyons school, and formed a paradoxical couple. , it was the intellectual rigor and prudence. had sometimes original ideas, but it had a remarkable surgical skill and a rigor. It is him which imagined the external knee, it is still him which introduced into the the concept of correction of the tibia. I remember to have made with him the first reintegration in France. Concurrently to some “extravagances”, Gilles was an extraordinary type. He taught me the intellectual reasoning, the surgical indication, in short he learned to me what must remain the basis of our Article That does not want to say that I did not learn anything elsewhere, but the advantage of it was that he had ideas constantly, he was innovating. One operated 7 a.m. 30 of the morning at 10 p.m., after one was going to dine and one remade the world of csotcina.comedy…

. : Every evening?

. : When I arrived at Saint-Etienne, I did not know this city, I did not know the … I never left the Pavillon 14 of the hospital during three or four years. The Senior registrars had an extraordinary operational program: in the same day I made a resumption of hip prosthese, an hip prosthese, then two of the knee, one or two tibial osteotomies, an ablation of hardware and I finished the evening around 9 p.m. or 22 hours. I operated four days per week. It was an university of surgery.

. : And the Shoulder “in it”?

. : Traditionally, the School it was the knee but there was also the famous one “butted” of shoulder of Albert . When I helped to make a Stop of shoulder of , I saw nothing there, I did not understand nothing there. It was a very small channel initially, one put a nail vaguely and when one does not understand, it is aggravating. was a Lyons general surgeon and its operation was known and practiced but I did not know it because in the services where I passed, in particular at , one made the nail of . In any event, at that time, in the years 1980, the shoulder surgery was not a very practiced surgery. I thus sought with better knowing the shoulder and I spoke about it in Albert who came regularly to Saint-Etienne because was its pupil cherished. One day that I discussed with Albert at it told me: “Then my stop… It is well? You believe in it? ” I answered: “It is well but I understand there nothing and in any event the shoulder it is not here that I will learn it, it would be necessary that I go elsewhere… ”. Bernard Moyen had already made me meet in Toronto Peter , raises of Charles . Then Albert told me: “It is necessary that you make the jump and that you remain six months in the United States, as me I did it, to learn the knee in the years 1950… ”.

. : What had you seen at Peter ?

. : The first time it was in 8983 1284, I had especially seen shoulder prosthesis and that went! People had a good postoperative mobility and these results convinced me. I had immediately understood the importance of rehabilitation because Peter insisted much on rehabilitation during the consultations, more especially as there were no kinesitherapists to ensure the postoperative continuations. Certain patients came ilometers to the north of Toronto, they were educated before the intervention by the kinesitherapists, one taught them a program from car rehabilitation and they set out again with their prosthesis and of the written recommendations of postoperative rehabilitation. I am gone back there one second time at the time of my stay at Charles to New York and there I remained four months there, in full winter by -30°. Constant which was with Peter , wrote its thesis on its famous score. An unforgettable moment together was spent.

. : How do you organize yourselves for this stay?

. : I leave my wife and my two infants in Saint-Etienne which I will re-examine only twice in six months. It is in 1985, I have a small purse of the and I make a banking loan. The dollar is with 10 francs!!! I speak some words about English and I do not know practically anything the shoulder. In New York, I place in an absolutely poor hotel in the district of Columbia and I “disembark” at . It is necessary to know which was at the time: the “king” of the shoulder, a star worldwide. During three days he does not address the word to me. The fourth day, he tells me: “You are really a French surgeon? I am astonished because you arrive per hour, you do not smoke and you do not put a question when I operate! I invite you to lunch”. I remained two months with . At the time it was David who was his and with which I linked myself of friendship. When one was at , one held the spreaders during one year and one had the right nothing to make and especially nothing to tell… But the type which had remained one or two years at had an enormous “commercial” value on the US market. It quickly found a post of surgeon of the shoulder in any group. Two things particularly struck me at . The first it is the meticulousness of its surgical gesture: it could have operated all the day but so at four o'clock in the afternoon it was not satisfied with a which it had just posed, it the whole, it withdrew cement and and told: “What I want it is a result which endures”. The second thing which astonished me it is its implication in rehabilitation. Sometimes when it made its turn around 10 p.m. with a flashlight, it told the patients: “I do not disturb you? ” It made them make years of car rehabilitation at 10 o'clock in the evening! It was not very talkative with the patients, with the limit of the kindness.

. : Is this scarcity of kinesitherapists, cultural?

. : I believe that it is at the same time a cultural phenomenon but also financial problems. There is not in North America of liberal kinesitherapists as there is on our premises. There is not, as you know it, of social security and even less vital card! The patient is obliged to deal with itself. They have a system where the kinesitherapists work in the hospitals, in the centers of surgery. The kinesitherapists will educate the patient before the intervention and it is very important. Before the intervention one will give to the patient the famous diagrams of rehabilitation of and one will explain to them what will occur and one will make them repeat the lesson. After the intervention, you will remain hospitalized eight days, one will rehabilitate you and after you manage all alone. It is thus indeed a cultural phenomenon. The French is not an American. It is also financial problems. I am amazed when I on our premises see patients who had eetings of rehabilitation. It is impossible to imagine that in the United States because the American would never pay eetings of rehabilitation! The good solution is, as usual, in the medium because I think that a kinesitherapist it is very useful. I speak of course about a kinesitherapist who works with his hands. There is a great tradition of kinesitherapy in France, especially in csotcina.comedy, and in particular in the Lyons School of . The kinesitherapist brings an indisputable aid. In the field of the shoulder, I do not see how some of my patients could have obtained their result without kinesitherapist! I think that the good system, if one wants to reduce the cost of an intervention and postoperative continuations, is to make both. I.e., to make rehabilitate the patient with a kinesitherapist, qualified manual and, and at the same time the while asking the patient to make meetings of car rehabilitation, at his place, all alone. I said it and I have written all that for twenty years.

. : Why somebody raised in the seraglio of the knee and the hip, decides it to be devoted to another thing?

. : I had and I keep a intellectual vision of the surgery and I am curious about nature. When I do not understand, I want to see. It should be remembered that in 1985, only which made really shoulder surgery in France, apart from Didier Patte in Paris, it was in Toulouse Michel which was a pupil of . There was thus in France, at that time, two “clans”: It there had the school of Leg, raises of with the Great Former Release and the Toulouse school resulting from which was that of Michel who made anatomical small incisions in repairs of cap and which posed shoulder prosthesis according to the principles that it had learned at . When I settled in 1986, for Patte I was “the American”. In fact this stay in North America marked me much. I settled with the project to create the first private unity of shoulder surgery in France. People looked me with large eyes. I began my liberal practice while continuing to make hip and knee at the same time as the shoulder surgery, but at the end of two years in 1988 I devoted myself exclusively to the shoulder.

. : Why did you give up a university career?

. : I settled in deprived because Gilles told me: “I do not have a post of aggregated for you. I can keep you as Attaché but there is no university budget heading for you”. was a young Department head, it had already aggregated which was Jean-Luc and there was thus no post for me. But, I had this passion for the shoulder surgery and when one has a passion the remainder is forgotten. For twenty years, I have made only shoulder, I devoted to it all my time and my weekends. That still impassions me to re-examine patients whom I operated fifteen years ago, and in particular the shoulder prosthese. It is always interesting to raise questions: “I did my work well, I rendered service”. As a surgeon of the private sector, I am obliged to confine me with a hinge if I want to have a complete activity. An activity supplements it is of course a surgical activity but it is also an activity of teaching which I made through trade-guild near young foreign surgeons who remained six to twelve months at home. It is finally a clinical research activity. It is also an activity of rehabilitation and training of kinesitherapists. That occupies the life of a man. Me that occupied me twenty years. I thus do not have time to make a complete activity for two hinges. The evaluation is important especially when one is in an exclusive square pulse, one is then obliged to evaluate its results, the goods and the bad ones, it is very interesting, one amends his technique, his indications, one tries to offer a better service to the patients. This work of publication must be made honestly. I never re-examined myself the patients for my work of clinical research. They are my “” which did it, without concession! I can tell you that returns to you humble…

. : This specialization gave you also a certain exclusiveness…

. : I was nevertheless not the only surgeon of the shoulder in the Rhone-Alps area! There were Jean-Paul but also Paul who had many ideas on the shoulder. At the time, was for me an engineering, it invented the every day but all its innovations were not beneficial… I had a kind of in North America where me the intellectual rigor was taught: “One does not invent every morning and one publishes only with two years of minimum retreat”. Paul it was an engineering in his kind but it was a little a “ (a)”. I came from an American school where the surgeon spent three hours to make a total prosthesis of shoulder which it removed in the middle of the afternoon because it was not satisfied. Thus at the beginning I was wary of Paul , whom I knew, because it was a pupil of and a buddy of Gilles . I went to see it thereafter when I started with better knowing the shoulder. It was the time when the weather was its channel initially with the translation of the . Time confirmed that Paul was an engineering with his idea of prosthesis reversed even if I remain still careful in the indications which seem to me abusive sometimes today… With my beginnings, my colleagues took to me for a dreamer with my poster “Centers Shoulder”, but they saw foreigners coming to visit me in this small private clinic of in Saint-Etienne. I had many visitors, French and foreigners, like both American, and JP. Warner, which was universally known, thereafter… I regularly continued to go to the United States to discover and learn the from the shoulder, in particular with Harvard in Los Angeles, Gene Wolf in San Francisco, in Charleston, in Van … I believe that I practically visited all the centers of the shoulder at that time. I have to make twenty-five return tickets. I acknowledge that I go on less journeys today. In 1989, I become the third French member corresponding of Surgeons after and . My godfathers are Richard and Harvard . I start to publish my results in French and North-American reviews. The adventure starts…

. : To have results, it is necessary to have patients. How did you persuade the rheumatologists?

. : I have to make five hundred ! My wife accompanied me. It was the circus of the shoulder! One arrived in backs rooms of restaurant of all the Rhone-Alps area, in the Loire, in the High Loire, to Auvergne, in the valley of the Rhone. I had recovered a good package of transparencies in Toronto and in the USA and I had become a true “sales representative of the shoulder”. At the same time, I have create an association to train kinesitherapists of shoulder. I made of it about two hundreds in all France with which I keep still today contacts and with which I always address patients. I see the collaboration of the kinesitherapists like a trade-guild. Each of the two parties adds its contribution to the building. I their told: “I need you, I make 50% of work but I need 50% of rehabilitation. You do not know the rehabilitation of the shoulder because you never had of shoulder to rehabilitate. If you want it, I can teach you the system which I learned in the USA: No the , not of weight but of the simple years that you will make repeat with the patients… ”. All the kinesitherapists whom I had in training course lit of the small focuses of shoulder, everywhere in France, in Bordeaux, at the La Rochelle, in , in Dole, and of course in all the area of the Loire, the High Loire, the Valley of the Rhone, but also in Paris! If I have a patient who lives the Ile de Ré, I address it to a kinesitherapist at the La Rochelle which I have known for twenty years and I know that my prosthesis or my rupture of cap will be perfectly rehabilitated and that I would have an optimum result.

. : The shoulder starts in Saint-Etienne, but with share, it there another Lyonese present, it is Gilles …

. : Gilles was very near to Didier Patte. Gilles belonged to a symposium devoted to the shoulder with the and it is as that which was born the group. There were Didier Patte, Gilles , Daniel Molé, , myself and I forget of it, that they forgive me… But I was not well seen by Didier Patte because I was “the American” and that I was a pupil of . When I went to see Didier Patte in Melun, me which left New York where had learned to me from small incisions with a respect of the soft parties and that I saw Didier making the “great former release”, I opened wide the eyes. I also saw his results of cap in consultation which did not impress me. Never I wanted to make this type of surgery. On the other hand, Didier one was impassioned and it is really near him which I learned the technique from triple locking that I continue to make today, as he taught it to me. and Patte, it was really the discrepancy. In France, in the clan there were and , in the clan Patte there was , Molé… Today, all that is finished and we all are plain within the European Society for the Shoulder surgery and of the Elbow…

. : How did you find time to publish?

. : I had beautiful customers, then for the publications it remained only the weekends… I did not see growing my children. I thus built a list of work like made Gilles besides and therefore we have much mutual respect. But this work was taken on family time and the leisures. It should be said that the adventure of the shoulder started in 1986 and we were obliged much to work and publish. Later I organized in 1996 in Saint-Etienne a European congress devoted exclusively to the pathology of the cap of the rotators. I did it with Pascal who is in Colmar currently and Thierry Thomas, rheumatologist, currently Department head in Saint-Etienne. Pascal was a little genius of the medical informatics and one has to re-examine more than one thousand of patients for this congress. All the patients were put on card, an enormous work. I had organized this congress like a large play, i.e. a character spoke and that two criticized it. It was the only congress where the seven hundred surgeons present who came from all Europe but also of the United States, of Japan, gave a note before and after each communication. For example, in the massive rupture of cap there were various therapeutic potentials, rehabilitation, the debridement , the scrap… Each participant had a small case and gave a note. One saw arriving on a giant screen for example in connection with the presentation on the scrap 65%, that wanted to say that 65% of the participants believed in the scrap . Then, at the end of the presentation, on the same subject, the surgeons . Thus if the scrap , for example, passed from 65 to 35%, that which had forwarded the scrap saw immediately that it had been not very convincing in its results. It was extraordinary. Of course, that did not rain with everyone especially with the surgeons and the likely rheumatologists… As for me, I fired as conclusion from this European symposium on the cap of the rotators which had to be repaired the ruptures and which the was going truly to invade the field of the shoulder surgery. That appeared obvious to me in 1996. One followed the Nord-américaine development: to unsling and leave an open cap by making a were not sufficient. It was thus necessary to repair the ruptures by .

. : Reinforcements of cap?

. : The last operated to have had a reinforcement of cap, not to confuse with a prosthesis of cap, it is my wife six years ago. The surgery evolves/moves, as well as the relationship between the surgeons and the patients, who become increasingly litigious. Today, it is necessary that the surgeon opens the umbrella and that it ensures a functional result as good as possible with a minimum of risk for the patient. However, to add a synthetic product such as the reinforcement of cap is to add a foreign body. I set up approximately five hundred reinforcements of cap and I must say that I did not have many complications. I closed my rupture with an osseous trench and I added a polypropylene reinforcement in order to protect this distal area which is inevitably a degenerative and fragile area. It thus was not of a prosthesis of cap but about a reinforcement of cap intended to be . I published this technique and the first results in Europe and in the United States. My idea of the reinforcement of cap was to avoid the iterative ruptures. However, we know that in repairs of cap there is an iterative rupture in approximately 25% of the cases, whether it is by repair or with open sky. I had made a publication on hundred ruptures of cap, repaired with open sky and without reinforcement and I had found 25% of Re-rupture with two years a minimum passing on a postoperative echographic study. The last multicenter study of and within the framework of the French company of finds the same proportion of Re-rupture, around 25%. This percentage is rather logical since one attaches a degenerative tendon which is fragile. The caps repaired by do not heal better or less although with open sky.

The second reason for which I have to stop the installation of reinforcement of cap is an industrial problem. The laboratory which developed this product me “released”. That did not interest them any more to develop this product.

My idea with my reinforcement of cap was to accelerate rehabilitation and to do without a splint of abduction which one forces the patient often today after a repair to protect the joinings during the first six weeks. I think that the concept of reinforcement of cap is always valid today. I must re-examine these patients but my regret is not to have been able to make an exploratory study, i.e. repair of cap without reinforcement and with reinforcement, with a review of the patients at two years of minimum retreat…

. : How do you approach your caps?

. : Today I repair all the caps by technique. Previously when I practiced the surgery with open sky I made a channel external vertical. However, the question which one can put is: is always necessary it to make an osseous decompression under . I have just operated by technique my wife on other side. She had a hooked type III and it was obvious that it had to be unpacked. One saw well the lesion higher cap and the lesion of the long biceps out of mirror caused by the beak . However, there are purely degenerative ruptures, without any mechanical conflict, and as indeed showed it, he then did not require there to unpack. In all the cases, if one repairs by a rupture of the cap of the rotators and that there exists a flat , decompression is completely useless… The should not be a therapeutic receipt to discuss a shoulder whose pains often originate in that it is initially necessary to discuss by rehabilitation…

. : You are in Saint-Etienne and the things are well. Normally arrived at this stage one makes of the policy…

. : You do not think so well of telling… Actually, I was bored, it was necessary that I move, that I discover other horizons. Alain Gilbert, the founder of “the Institute of the Hand”, had contacted me in 1996. I had declined his offer because I organized my European symposium on the cap with St-Etienne. I owed something at this city where everyone had helped me much and I wanted to organize this congress in Saint-Etienne. Two years later, I recontacted it to ask to him whether its offer were always valid. I thus left to Paris, for new adventures, the day of my 50 years! It was not at all from the point of view careerist, but I wanted to face another challenge. That made funny disembark at 50 years with its small bag in Paris. I lived with the hotel three months then in one furnished during one year. When I arrived at the Private clinic on April 2nd, 1999, I was very well accommodated by the group of the Institute of the Hand. I lived three to four years of happiness in my trade of liberal surgeon, with the Private clinic. After, arrived the 35 hours, restructurings, the problems of personnel, the reduction in the professional quality of the managing staff… I think that the 35 hours it is the greatest catastrophe which arrived at France since good a long time. It is destroying for medicine as well in the public area as in the private sector. The 35 hours have, in my opinion, “killed” French medicine. One will go back from there with difficulty. Therefore, three years of happiness in , then as in all the private clinics, of big problems…

. : How that did it occur with respect to the customers?

. : I tried to implement to my customers of Paris the same principles as those which I had used among my patients inhabitant of Saint-Etienne but it should be said that the Parisian patients are more difficult to manage. They are people “stressed much more” who in the Loire or the High Loire. I think that we are currently service providers i.e. the patient lost the respect of the surgeon. Historically, there was the priest then the teacher and now one abolished the medical capacity. I think that it is a great fault of the doctors of having let settle this lack of respect. On 10 patients in consultation, two or three do not come, without us to prevent. This lack of respect is more shouting in a great agglomeration like Paris that in a provincial town like St-Etienne.

. : Which is your activity?

. : I see shoulders, i.e. I have a medico-surgical activity in the field of the shoulder. I roughly operate a patient on four, the three others I deal with them by a specialized rehabilitation. I make neither of the surgery of the peripheral nerves, nor the surgery of the tumor. I consider that the tumoral surgery must be dealt with in hospital service where there is a specialized team. The private sector and the hospital sector are for me two complementary sectors. It is not the role of private to make surgery of the tumor. In my surgical activity of the shoulder, I currently make 80% of surgery, especially of repairs of cap. In the field of former instability, I remain faithful to the surgery of triple locking of Leg. I also make capsular surgery of , in particular in instabilities at the and I tend to make it currently more by that with open sky. I also make surgery with repair of in the sportsmen who do not make a sport of contact. Lastly, I do much surgery of the prosthesis which is a surgery that I like much. I install more anatomical prostheses than of reversed prostheses for which my indications are careful. Besides that, I did not change my system of postoperative continuations i.e. I consider only rehabilitation made 50% of the results. I rehabilitate and I softened before the intervention; I never operate a shoulder , and I test the motivation of my patient by rehabilitation. In the great massive ruptures of cap, for example, I often have patients and I start by rehabilitating them. They are often old patients and if they do not have any more pains after rehabilitation and that they recovered a mobility activates normal, I leave them in the state because it is not possible to return the muscle force to them. If they have persistent pains in connection with a long degenerative biceps, I propose a epic to them and I carry out a of the long biceps. If they have a defect of former front elevation activates i.e. a paralytic shoulder pseudo, in spite of a specialized rehabilitation, which is rare in my practice, I propose today a reversed prosthesis to them. I waited a long time before putting to me at it. When the rate of complications of the reversed prosthesis is seen as that was brought back during the last symposium of the in November 2006, one is cooled a little. It is not an alleviating surgery and all the solutions yet were not found. The reversed prosthesis renders service but I do not know if it should be thought of it in front of a fracture at a 70-year-old and if it is not to better rebuild the tuberosities around a prosthesis, as Pascal showed it perfectly to us.

. : What is nine in shoulder prosthesis since ?

. : Initially the majority of the surgeons remained faithful to the initially delto-pectoral channel. Then, the problem remains that which existed in the years 1980, i.e. the metal junction patching and polyethylene. My old prostheses of which have more than twenty years, which I had the occasion to re-examine for the conference that I organized in 2005 with the Institute of the Hand, go well as a whole. There was then the stage of the modularity of the humeral head of Nord-américaine influence, where one adapted the prosthetic head according to the size and that was a progress. Then there was the big step, resulting from work of Pascal from where was born the concept of prostheses known as anatomical, with also work Christian Gerber. It is sure, that renders service, because one approaches more anatomy. Is there a real gain? It would be interesting to make an exploratory study on 50 centered primitive operated by the same surgeon with the same type of rehabilitation by putting a prosthesis of II among 25 patients and an anatomical prosthesis at the 25 others and to be able to objectively compare the results with five or ten years… At all events, the problem which remains is that of . All the studies show that the patching of improves the results on the pains and mobility compared to simple humeral prostheses. In my experiment, I put a only when I am certain that I will give all the chances to this “to survive” a long time. If I have an important retroversion of , if I am obliged to mill, if I do not have a good osseous capital, if I have a defective cap I do not put . Simple humeral prostheses, that I re-examined with a long passing, do not go so badly only that. In addition, one returned from without cement because there were many problems of reliability on the level of the behavior of this type of in the bone. Lastly, another question which arises it is: Is it necessary to put a at keel or studs? It is a vast debate. The with polyethylene keel at content convex and cemented have a great retreat today. I think that the technique of compaction of with the cancellous bone which I have focusing and which I use since 1997 allows me to clearly decrease the problem of the perished edging and thus the risk of long-term unsealing. I will re-examine into 2007 the longer-term results of this technique of compaction with cancellous bone. In any case, according to what I see during my consultations, I have very few edgings around with more than five years. With regard to with studs, that would interest me to see the long-term outcomes because I think that it is very difficult to see an unsealing or an edging on the level of the stud. The option of which puts two screwed studs out of titanium and of cement is an interesting option.

. : How do you see the share of private in teaching?

. : For me, the surgeons had all the same course, and each one has something to show and forward. The problem is of knowing how to organize teaching when one is surgeon in liberal sector. Initially by leaving the open gate of the , i.e. by accommodating all the French colleagues or foreigners who want to come to see you. But the transmission is not done solely on the level of the it is also done during the consultations. The shoulder surgery is a surgery of indication and it is important to continue to listen to the patient, to know his complaints and to examine it before precipitating on the standard imagery MRI, or arthro-MRI. When one is surgeon in deprived, one is unfortunately not with the choice of the interns of the , which is unhappy besides for the ones and the others, and in particular for the young people because that is always interesting to see other professional practices. I have formed for twenty years a dozen foreign surgeons who came from the whole world and with which I kept a permanent contact. These surgeons came from Israel, of Lebanon, of Tunisia, of Egypt, of South America, of Belgium, of China, etc On the whole, when one exerts in the private one, one can make a very beautiful surgery by earning its living honestly but one can also make clinical research, write publications and make teaching. One can organize a valid teaching in deprived and it is the role of the laboratories which can offer purses to the young foreign or French surgeons. The laboratories can and must be patrons on the training level. The surgeon in the private one must sign a contract of consultant with a laboratory, like that is done in the United States in exchange of a purse. That offers a double advantage, initially you can forward your knowledge and educate the surgeons who always do not have the means of learning in their country and then that renders service to you. I had for example during the last year a surgeon of Shanghai which had an obligation not only to help me with the surgical unit and to attend my consultations but it was to also leave at least two publications in an international review after having re-examined the patients. In these cases there, everyone is gaining. He, because you forward your knowledge to him, and you because it helps you in your scientific work and because you progress when a young person asks you questions all the day. Lastly, the laboratory patron is gaining because it will have done nothing but sell one implant but that it will have taken part in the training of a surgeon…

. : You do not regret having left St-Etienne?

. : You know, I remained the two feet in my shoes and I never lost the contact with Saint-Etienne where I kept my house. I did not take the famous person. I continue to go to the football game to Geoffroy to support the ADZE. One even proposed to me to be a Departmental manager in Saint-Etienne, but at 57 years, in France, one is too old, in spite of a local consensus.

The technocratic rules of the ministry prevented me from having this post which would have rained me much. I do not regret having left Saint-Etienne and I continue to live an great adventure in Paris.

The message that I would like to give to the young people is not to let itself gain by the . The surgery is a fantastic trade, but which one can make well only if one is available to 100%. Even if one lost part of our has in an administrative and pseudo system sedentary, that remains very gratifying to return to a person a function thanks to an surgical operation or to a rehabilitation… When a patient tells you: “Thank you, I do not have any more pains and I go well thanks to you, you made a fantastic trick”, you not only return to trust on your premise but you have the impression to have really rendered service. I will finish by quoting my owner, Gilles who told: “The surgery is Article This art is a craft industry. Like any craft industry, this trade is learned by trade-guild. He learns himself thanks to the sensitivity and the passion of the men who teach it and the men who learn it. Today one wants all to rationalize but attention not to destroy the talent and the imagination of these creators. The man is not a mechanics of the solids and fluids, but a being sensitive to which he is necessary to show and insufflate the beauty of the life so that it can cure”…