. : How did you know Jean-Pierre ?

R.G.: Jean-Pierre was my instructor at the university of Columbia and I could appreciate all his talents in csotcina.comedy. At the time, Jean-Pierre worked in a hospital which is called Hayes, and I met it at the time of my last choice of resident. But that did not make time badly that everyone told me “You will see, you who speak French, this type , he is fantastic.” I was not disappointed.

 

. : In what was it fantastic?

R.G.: Jean-Pierre was very different from the other surgeons in whom I had passed insofar as it were interested enormously in teaching. As of the beginning, it took to you by the hand and it taught you very A to Z. other surgeons came to make their operation, to teach that a little and there, but Jean-Pierre, it, were really interested in all the interns. Its reputation was done very quickly and all the interns wanted to pass in his service. It invited us at his place because he was also excellent chief cook and around a leg with the string, one discussed such complex clinical example or such original technique. One day it left us a banana the refrigerator to explain us an osteotomy! Moreover its presence in Columbia was very exceptional. In general the foreigners are not very accepted in the world of American medicine.

 

. : You usually speak French…

R.G.: My parents are of French origin and I studied with the French college of New York.

 

. : How did your decide?

. : I had always been interested in joint prostheses. I was engineer at the university and in the surgery of the prostheses there was a mechanical aspect which impassioned me. At the end of my boarding school, Jean-Pierre recommended to me to go to France and to visit Philippe in order to leave the American routine.

 

. : What did you think of France of this moment?

R.G.: In 1985, I was 32 years old and I was charmed of really being able to use my French. I was glad to note that France had well advance in certain fields. In fact I suspected it already because at this period in the United States one began just the locked nails which came from France. In practice, I discovered the world of the ball joint and the world of the prostheses where France had advance well on the United States.

 

. : What the most struck you in practice of ?

R.G.: Initially it had a vision of the problems of ball joint which did not exist in the United States. It had a plan, a concept and an therapeutic approach which I had never seen before. To the United States the surgeons generally did not realize that there was a patellar problem. Because the pain is not always typical, it is not always in front. Philippe mentioned a patellar problem even when the pains were side. The concept of the rocker of the ball joint was something that one had never taught me. looked in which plan was made the rocker of the ball joint. Then, it palpated the breakages of the ball joint, and it had a very systematic study plan. One could agree or not agreement but it had its therapeutic plan; for this kind of rocker and angle Q of the quadriceps, it made this kind of operation, and for another pathological situation it had another operation. In the United States, the large surgeons of the knee did not have a systematic plan. It made the same operation for everyone. Sometimes that went, sometimes that did not go. It is still about true, the surgery of the ball joint is less foreseeable and less gaining on our premises, but it was particularly true in the surroundings of 1985.

 

. : There were nevertheless good concepts of patellar instability in the United States?

R.G.: Not, it was fuzzy. There was the school of Jack which is a great name of the knee and ball joint. It had an important recruitment of sportsman and it is besides one of the first which showed that the patellar problems are not found solely in the girls. It was one of the first to describe in the United States the transfers of tuberosity but that had already been done in France with Albert . It is still a little the problem in the United States, the surgeons know only two operations: either release of the external aileron or the transposition of the .

. : And in the field of fémoro-tibial osteoarthritis?

R.G.: In the United States we had the choice only between the total prosthesis and the osteotomy of the tibia. Nobody in New York posed prostheses . In New York one always taught me that the prostheses were really much lower than the total prostheses. As intern, one believes all that one tells you, I would never have thought differently if I had not seen the results of Philippe : its patients were followed at three years, five years, ten years and indeed that seemed very well to go.

 

. : How are held your professional beginnings?

R.G.: In New York, after a one year at and I start in the private one and I am interested in the hips and the knees. I operate in Joint and I report myself that it is a hospital where there are already two other surgeons who make only hip prosthese and knee. Then I realize that it is necessary that I implement the “Zoulou principle”, expensive Jean-Pierre . I told myself that I had interest to focus me a little more on the prostheses and on the problems of ball joint. I was as interested in the laser in csotcina.comedic surgery and all the innovations by telling me as there would be well one of these seeds which would push. A posteriori that especially was the ball joint.

 

. : In practice with which end did you start?

R.G.: I started and I always continue in the field of radiography. I had some ideas on the Alta, how to detect them etc… and that launched me in the world of the ball joint.

 

. : Which are your therapeutic guidelines?

R.G.: It is 99% of , and 1% of surgery.

 

. : And in this 1% of surgery…

R.G.: Initially I do not want to pass so quickly on the physio because what I learned with the passing of years it is that all the forms of physio are not equivalent. If which is not familiar of the patellar problems, there are chances so that the patient has even more pain, which besides is perfect for a surgeon who seeks to operate at all costs. Contrary if it or is very informed, there are high probabilities that the patient is better. For the surgery, I am completely of agreement with the European school which tries to adapt the surgery to pathology. I passed to Mr , large surgeon of the shoulder. At time when whatever the repeating luxation of the shoulder everyone made the same intervention, tried to him to see exactly where was the fault to repair. It seems to me that for the ball joint it is similar. The shoulder it is especially the surgery of the soft parties, in the same way the ball joint it is also in a great measurement of the surgery of the soft parties. There are also all the problems of dysplasia of ball joint and trochlea. It is an idea which is strictly European, French and Belgian. American does not think at all of the problem of the dysplasia, they often pass to side. The radiologists are not centered at all towards the ball joint. When a patient passes a MRI they always do not make an axial cut.

 

. : How do you take charges the dysplasias with them?

R.G.: A little like Europeans, I grope a little. In the trochleas very punts, I lean rather towards the digging of the trochlea but it is really an exceptional surgery. At least, I have satisfaction to recognize that there is a problem. Instead of suggesting with the patient a small section of the patellar aileron, I inform it that the problem is serious and that it will be necessary much more than one small section of the patellar aileron to solve it. Already, I avoid with the patient of the useless operations.

 

. : An ingenuous question: why the ball joint make does badly?

R.G.: Very complex question! Like says it Jean-Yves Dupont, it exists multiple parameters with variable clinical penetration. In other words there are many mailmen which contribute to the patellar pains. Initially one can schematically consider that there are two different patellar symptoms, which of course intersect: it there with patellar instability and the patellar pain. Both do not go necessarily together; many patients who are unstable do not have pains, and many patients who have pains are not unstable. Instability in a direction is easier to understand because it is purely mechanical. One can explain instabilities by mechanical parameters which one can visualize with the imagery. It is the dysplasia of the ball joint, it is the vast internal one which starts or which finishes too high, it is the external condyle which is too flat, etc… Instabilities, one is able to explain them but the pains without instability are quite difficult to understand. The theory which comes from Europe, it is the , it is the theory of . And I believe that it is valid. The subjects which have patellar rockers have ; they do not have can be not all evil, but the is certainly a mailman which supports the pains. In addition in these external rockers patellar, with the scanner, one sees that the bone under is thicker on the external cheek what confirms than there is a on this level. Even if the cartilage itself does not have nerves, the bone him in A.

 

. : Not much!

R.G.: There is enough of it, when one knocks the hurt knee that. Of course, the synovial one has also nerves. The perhaps primarily intraosseous and this is why certain surgeons make patellar drillings and observe clinical improvements. It is as possible as the patellar rockers cause problems of venous flow source of intraosseous ; thus when one makes a section of the external aileron, one would correct at the same time the rocker and the problem of venous flow.

 

. : As regards prosthesis how did you evolve/move?

R.G.: As I said it previously, I took the option of the innovation and I decided to test all the innovations. In the hip, I used an extremely expensive prosthesis which was called , it was a prosthesis made to measure and i.e. during the intervention. A mussel of the femoral cavity was made and while was prepared, in the part at side, with computers of the lasers and advanced technologie, a prosthesis was manufactured with exactly dimensions of the interior of the femur.

 

. : And sterilization?

R.G.: As soon as the machined part, it was sterilized. That took inutes in all, manufacture and sterilization. It was the principle of the key-minute! Of course the prosthesis was extremely expensive, i.e. about
7.000$ in 90. It was really extraordinary until the moment when one reported oneself that did not go. Most of operated had badly and they practically should all have been taken again. I had also unhappy experiences with the prostheses without cement which were with the mode in 1985 and which were at the origin of major osteolyses. Of resumption in recovery, so much for the hip than the knee, I ended up becoming very careful vis-a-vis the innovations. I decided to pose prostheses certainly imperfect but which were known for a long time. The day when it will be proven to me that there is a prosthesis which is better thanks not to a computer but to a clinical retreat of 15-20 years there I will be ready to change.

. : What you of the surgery computer-assisted, etc think…

R.G.: One can have two philosophies when they are prostheses without cement. Either the fact is accepted that the prosthesis is in contact with the bone only in certain points, which is the case in the great majority of the prostheses. And one is satisfied some. Even with our prosthesis the contact was not perfect. There was between 85 and 95% of contact. Thus there was always from 5 to 15% of noncontact in these prostheses is telling perfect. Either it is wanted that there is a contact everywhere. It is the ambition of , and it is necessary that the prosthesis is in contact at 100% because if not the usual techniques are largely enough. With my opinion, with the hip, the surgery computer-assisted is especially interesting for the installation of the cup because we badly manage to judge its guideline. There is a study which was made in Sweden or of the surgeons of the hip tested tried to determine which was the of their . Then they made pass operated to the scanner, and they recognized that even if the surgeon had much experiment, he judged this rather badly. Sometimes there was even 15° error what is enormous. There I think that a more reliable system with points and objective measurements, could find its place. In addition there is also the problem cost. The majority of those which need hip prosthese have more than 70 years and for them, a conventional prosthesis will last all the life.

 

. : In which field do remain you innovating as regards joint replacement?

R.G.: In the field of the ball joint. I pose prostheses of ball joint. In France there is nothing extraordinary with that but in New York I am the only one to do it. I do not pose any much but I pose some.

 

. : Which do you pose?

R.G.: I start to pose a prosthesis manufactured by and which belongs to the , in other words it is the mobile ball joint of prosthesis . Opposite there is a shield which with the form of prosthesis .

 

. : Summers you content with your results?

R.G.: On seven cases one can nothing tell. For the moment I am satisfied. Recently I discussed Canadian 40 years which had a terribly ball joint, and a very advanced osteoarthritis. It had already had all the possible operations and it could hardly go and fold the knee. It remained more like therapeutic option only the , or the total prosthesis. At 40 years, I chose the prosthesis of ball joint. Three or four weeks later, she wrote to me of Canada to think that she was charmed and that she had even been able to dance. She even asked to me whether she could make a “small ski”. That made 20 years that it had not had such a painless knee.

 

. : From total the prosthesis point of view of of knee, how did you evolve/move?

R.G.: During my boarding school I knew only completely conventional prostheses. When I came to Paris, I noticed that Philippe made use of a prosthesis with mobile plate which practically was behind manufactured at home, i.e. in the New Jersey. I found the principle remarkable. I had already heard of this prosthesis but in New York, the csotcina.comedists are strongly influenced by , and with him, they said that it was a weak idea, that the prosthesis would never last, that the polyethylene stem in the metal base plate would break. When I saw that operated of Philippe were well, I said myself it was perhaps an good idea. For this time, I have posed only that. Maintaining the plate mobile is with the mode, and even had left a model. Blow all its pupils in New York will say from here a few years that there is only that of truth. They will forget all that 15 years ago they found that weak.

 

. : Did you make search?

R.G.: After having started to operate in the private one, I am turned over on a university post to the university of Columbia. I was clinical Director of search on the knee. The Director of the laboratory is a researcher extremely known in the world of the cartilage. He is called . The laboratory was divided into anatomical section. There was the shoulder, the knee, the rachis. Me my section it was the knee and especially the ball joint. I spent several years to study the cartilage of the ball joint. In the clinical research one expects to have relatively immediate results, whereas in the fundamental research that is spread out over years. The weather takes years for simply preparing the study, then to obtain appropriations, then to be during the study, and finally to see appearing results.

 

. : Which was your project?

R.G.: One analyzed the properties of the patellar cartilage which is different from the other cartilages in several connections: cut, biomechanical, biochemical. The patellar cartilage is different from the cartilage of the trochlea. It was checked since this phenomenon is found in other hinges, in other words that the cartilage on a side of the hinge is not completely the same one as other side.

 

. : In what does defer it?

R.G.: In thickness, the patellar cartilage is thickest of the human body. There is up to m thickness whereas the cartilage of the trochlea has two or three millimetres. Moreover the cartilage of the ball joint is specific insofar as it does not follow contours of the bone, in other words the radiographic radiograph does not allow to provide for the form of the cartilage. Then the cartilage of the ball joint is softer than the cartilage of the trochlea. The cartilage of the ball joint is more permeable and water re-enters and leaves much more easily in the cartilage the ball joint than in the cartilage the trochlea. Because of all that the deformations of the cartilage of the ball joint are much larger than the deformations of the cartilage of the trochlea or any other body part. It is possible that these deformations are the cause of the frequency of the patellar gristly lesions compared to the other hinges. And in all the cases, there are more lesions on the patellar slope than on the slope .

 

. : Do you think that there exist great differences in thought between an American and French csotcina.comedist?

R.G.: With my direction there are some less and less. American takes conscience of European work more and more and there are more and more exchanges between the young surgeons. Thanks to Internet and with its powerful engines of search, it is easy to have at disposal the international literature and the majority of the French items have an English summary. There are thus no caricatural differences between the French and American surgical thought. While reflecting, I find only differences anecdotic between the surgical practice of the two countries, as for example the fact that the cloakrooms are always strictly separate in the United States.