. : What led you to create this exchange rate?

. : Quite simply because in 1989, I attended , with the one of the first exchange rates of surgery of the shoulder. I made then my six-month period of intern inter-CHU in Lyon, at Henri and I worked much with Gilles . One day, Gilles gave me a leaflet while telling me:
“, Looks at, that with the air well, you Hold should go perhaps there…” It was the exchange rate of surgery of the shoulder of , organized by Jim . I thus went there with Christophe and we were amazed to find us with the great names of the of the shoulder: , , … We listened to their communications, but especially we worked with them on plastic models and at the laboratory of anatomy. They and one could ask them all the questions which one wanted and it was for us extraordinary. I told myself that this type of exchange rate missed in France and Europe. I returned from there with from the start the project to organize one day such an exchange rate in Nice. For the little story, we had gone there when the dollar was with more than 11 F and the voyage and the exchange rate cost approximately in the 99 010 Francs. Blow, before leaving, I had had to make a loan at the bank, which I refunded during all my , but I never regretted it because it was an excellent investment. It is what enabled me to launch out in the of the shoulder!

 

. : Had you anticipated the success of the of the shoulder?

. : With beginning of the year 90, with Gilles we had been cooled a little by the poor outcome of former glenohumeral stabilizations, but it was felt that there were enormous possibilities. It should be said that we less better know the pathology of the shoulder and that the has enabled to us to better understand certain lesions. It should be also said that we did not have then all average the techniques to repair.

 

. : I.e.?

. : There were not yet the anchors. I think that anchor revolutionized the possibilities of the surgery of the shoulder. To stabilize the shoulder, one made the technique of which consisted in passing from the joinings trans-scapulars and to tie them behind on the infraspinator. They were not very good like technique and one had 40 to 50% of repetition. But operated which was well… really went very well, and they were not taken again. At the time, one made especially under . After the exchange rate of , I had gone to return inspection to Harvard , in Los Angeles, which had been the first to develop this technique. It was practically the only current operation which one made. One could nothing make of other and still, often that bled, one did not see anything… it was terrible for the coronary ones!

 

. : Let us return to the exchange rate; it is really remarkable by its quality and the very international side of the oral hearing…

. : From the start, my ambition was to make an international, high level exchange rate of them. Therefore it is in English, although one is in France. Besides that made to certain French who have evil to understand certain questions or certain interventions. But unfortunately, if one wants to really make an exchange rate of European or worldwide level, it should be done in English. There are as many foreigners why? … I think that there is a real request on the shoulder surgery in general. This year, one received 250 surgeons come from 26 different countries, of which very remote countries like Australia, New Zealand, Japan, Saudi Arabia, Nicaragua, Norway… It is pleasant which all these people .

 

. : Why to have mixed “ and arthroplasty”? …

. : It is true, that can appear odd… but indeed, “Nice Course” relates to at the same time the and the joint replacement of shoulder. I wanted from the start “this co-education” because I had noticed that people often begin their experiment while putting themselves at the of shoulder then find themselves with the recruitment of open surgery and prostheses… of which they do not have any experience! … Conversely, certain surgeons have good experience of the open surgery and would like to put themselves well at the … but do not dare to launch out like that, which is understood! … Therefore, during the exchange rate, the afternoon are reserved for the practice on plastic model of shoulder and for the laboratory of anatomy. While the morning, there are communications gathered by topics and I try to leave a broad place with the discussions and the roundtables. That makes it possible to know what really “the experts” in practical situations do and one tries to avoid “the set language”. The aim of the exchange rate, it is to give the last tendencies pathology shoulder surgery, while making it possible to the surgeons to have a very practical approach thanks to the workshops.

 

. : What is nine for somebody who is not specialist in the shoulder?

. : On the former instability of the shoulder, that which one is about sure now, it is that the losses of bone substance on the level of and in particular, the are formal counter-indications with stabilization. In the same way, the great notches, the great lesions of , are clear counter-indications with the . There were several communications which confirm this data and that joined my experiment. The methods of closing of the separation of and capsular go, but they have their limits. In the same way, an instability in somebody who forwards a of the shoulder is an indication to make a stop.

 

. : What is it the on the level of the shoulder?

. : The had been defined at the time of the symposium of the by an external rotation, bends with the body higher than 85°. In fact, that corresponds to a with former, usually congenital. Our experiment is that there is necessary to remain very careful in the indications of “” among patients forwarding a former , especially if he are very young. It is clear that a can forward a traumatism and be made a lesion of , he can be luxated and there, it should be operated… but the fact that it is is penalizing. For my part, I think that it is also necessary to take into account the with lower prevalence, which it is rather acquired, secondary to repeated luxations or subluxations and corresponds in fact to the lower distension of the capsule. It is detected by an asymmetrical hyper-abduction with the test of , with more 20° of differential or an impossible test, because of apprehension. Philippe showed besides that one could try to quantify this lower by a dynamic radiography in hyper-abduction. When there exists an asymmetrical , therefore a lower , I associate a gesture of lower capsular , in addition to the reintegration of the former pad and former capsular .

 

. : One did not hear of thermal capsular retraction…

. : Yes, it is funny whereas everyone spoke about it, a few years ago… It was even, appears it, the intervention most practiced in the United States there are 3 or 4 years! touched a word of it to say that the indications are very limited: only like addition to common operations of capsular and reintegration of the pad and that today, it took again all the complications.

 

. : Which complications?

. : Serious complications. There were burns of the nerve ; there was complete destruction of the capsule thus without true possibility of surgical recovery or with much of difficulties. There were cases of lysis of the cartilage with osteoarthritides at subjects of 20-30 years which are dramatic. It showed cases of recovery per shoulder prosthese, with patching of , at some 25 year old kids! It is all the difficulty of our trade: there is landing gear which should be taken and not … and there is that it is necessary to let pass!

 

. : Where is one percentages of success of stabilizations?

. : I think that there is an incompressible threshold below which one will not be able to go down for the “”; I want to tell below 10 to 15% of repetition. Even if today, one learned with better retightening the capsule under by taking into account the plastic distension associated with the lesion of , there are capsular lesions which are not accessible to the , as had shown we with the with Laurent . And an intervention like , acting only on the soft parties, will be able to never stabilize a shoulder which forwards losses of substance. While selecting the patients well, one can go down to 10% but one will never arrive at the 5% of the stop. It is not only one question of technique… even if the technique is important! On another side, the stop has its disadvantages of which account should be held. It does not give as much repetition, but there are lyses of the stop, malalignments, disassemblings… and it is not an easy operation. It was besides rather funny to see, during the exchange rate of Nice, American, , which is an unrepentant , to explain us how to make the operation of ! As said it Christian : “… soon, it will be learned that the stop was invented by “” and that it is of Mineapolis!!! ”

 

. : What do you make in the event of large notch of ?

. : When there is a large notch, I make a stop. But you surely listened to the presentation of Wolf Gene which the infraspinator in the notch under : it calls that “ Remplissage”… It is pushed thoroughly the “”, and sometimes that leads to a little odd operations! It also showed us how one could stabilize a disjunction under !

 

. : And what is nine on the cap?

. : There were very interesting communications on the cap of the rotators. I had voluntarily put at the program discussed subjects, like that of the place of the in repairs of the cap of the rotators. I had asked to bring back to us his experiment of repairs of the cap to open sky without . It was interesting to intend it to say, whereas it is a former student of , that it does not make any more a of principle when it repairs a cap. He thinks that the subacromial hinge is a true hinge and that it is perfectly formed with the convexity of the capped head. Therefore, for him, there is no reason to make a and it never makes any, of principle. It showed its results, which are good… in any case, not worse than those of the others! , as for him, forwarded a randomized exploratory study of isolated repair of the know-thorn-bush, with and without , at the patients forwarding a of the type II, i.e. curve. It showed that the result was identical that one makes or not a ! … Astonishing, not? … French side, Daniel Molé brought back his experiment of the isolated in the nonreparable lesions from the cap by saying that the re-examined patients with very long term, to more than 10 years, go always well. It is very interesting because one could have thought that the results were going to worsen with time, but according to its experiment, it is not the case.

 

. : Concerning the partial ruptures?

. : Initially, which should be known is the etiology of these ruptures partial of the deep face of the cap? Gilles pointed out the existence of the “conflict postéro-superior” which can explain certain ruptures partial of the deep face of the cap, at the young and sporting subjects, in particular those which practice sports of launching. During the maneuvre to arm with the arm, there exists a contact between the deep face of the know-thorn-bush and the edge postéro-superior of . This contact, if it is physiological, can become pathological when it is repeated hundreds of times. There then exist usually lesions associated with the pad postéro-superior and deep face of the cap; therefore it is said that there exist “lesions out of mirror”. There too, the does not bring anything since it is a mechanical conflict interns and not external; the is thus not the solution. The processing, it is especially the setting at rest, the stretchings and the change of the sporting gesture; in the event of preserving failure of therapy, one can make a debridement of the lesions… after, there is debate on what it is necessary to do.

 

. : And degenerative partial ruptures at the older subject, then?

. : The tendency is to propose a repair of the lesion even if it is only partial; the simple debridement and the disappointed. There was a more technical debate with Jean-François and Alex on the possibilities of repairing these ruptures partial of the cap under with two techniques which are opposed a little. , which is a pupil of , high with the and the onomatopoeia, calls this major rupture partial the “ lesion”, which means “Partial Tendon Avulsion”. As Alex is Italian, I had entitled his communication “ C ? ” Approximately, it discusses the ruptures of the deep face of the know-thorn-bush by in situ joinings. It passes the anchors and the joinings through the surface layer of the tendon and moors on the osseous area revived to reintegrate the partially broken tendon. The other technique, and which are that I adopted, it is to worsen the lesion, to open the roadbase of the tendon who am often very thin, to transform the partial lesion into a true rupture and to carry out “a true” repair of the cap under .

 

. : Precisely, that is it results of repairs of the ruptures of the cap? Does it go?

. : The results are astonishment good… even if,
technically that is not obvious at the beginning! I tried to simplify the technique by doing what I call one
“staying of the cap”. That consists in making points in “U”, in order to implement the tendons well to the revived and putting the anchors at the side face of the , where there is solid cortical bone. I started into 98, but without believing in it too much… I used besides anchors and joinings because I had told myself: “if that fails, I could always take them again with open sky and I would have a virgin shoulder… ”. At the time of the exchange rate, I paid, our experiment of repairs of the know-thorn-bush with this technique: we have 95% of satisfactory results objective and subjective and 70% of tight caps, checked by … what is not more badly than with open sky! That can appear paradoxical, because repairs are obviously less solid than with open sky… but our clinic experiment is satisfactory and pushes us to continue. It should be also said that I protect repairs by a splint from abduction during 6 weeks and that I do not send the patients at the physio before 3 or 4 weeks. The continuations are astonishment simple. I think that the fact that the patients profit from blocks inter-scaléniques prolonged and do not suffer into post-operative is there also for much because that takes part in the protection of the joinings. What is remarkable with the , it is that it makes it possible to make the same gestures of release of the cap as to open sky, if that is necessary.

 

. : What of other on the cap? …

. : I appreciated the communication Christian Gerber on the last scientific projections concerning the physiopathology of the lesions of the cap of the rotators. He showed that among patients having a rupture of cap, the is more prominent at the side level. In addition, he also said that the exaggerated retroversions caused lesions of the subscapular rather, therefore former lesions. Conversely, the would give rather lesions of the , therefore posterior. Especially, he spoke about what one does not call any more maintaining the degeneration lubricating muscular, but the muscular lubricating infiltration of the cap. He showed that this lubricating infiltration is indirectly related to the retraction. Indeed, there is not rarefaction of muscle fibers but affixing of lubricating layers and this would be due to a change of obliqueness of muscle fibers after rupture of the cap. As the retraction of fibers amends the angle of the warp ends of the muscle, in the event of rupture of the cap, the architectural provision of fibers changes and free spaces fill of grease. This could explain partly that the lubricating infiltration is not reversible, like had already shown it Daniel . The fact of repairing the cap and of relieving the patients does not improve therefore the lubricating infiltration.

 

. : You do not have turned out badly around the tendon of the long portion of the biceps

. : Yes, it is a little my hobby-horse! The long biceps is a major cause of pains of the shoulder but that can also be the cause of limitation of mobility. , one of my English , forwarded what I called “the long biceps out of sand glass” which can be a source of pain and blocking of the shoulder. That corresponds to a hypertrophy of the intra-articular portion of the biceps which is found trapped in the hinge and cannot any more enter in the cable routing channel at the time of the last degrees of front elevation or abduction. To schematize, this hypertrophy corresponds a little to that which one can find in the “finger with projection”, on the level of the hand. I think that there is a certain number of bicepses out of sand glass which one takes for and which one wrongly, at the physio. This last must then force to try to recover the former front elevation in these patients whereas it is acted in fact of a true mechanical blocking of the shoulder related to a hypertrophy of the tendon which cannot engage in its cable routing channel. It is as if one sent a patient with a handle of bucket of the knee at the physio so that it recovers the extension! …

 

. : Which is the essential symptom?

P.B.: The patients usually consult for pains of the shoulder and are limited in the last degrees of front elevation. By examining them, one discovers that they miss them 20 with 30° active and passive former front elevation. It is necessary to examine them in laid down position, released well, the folded knees and to ask them to extend the arms above the head. Healthy side, the arm can be brought in the plan of the review board, whereas other side, the patient cannot extend its arm completely. If one forces on the arm, to gain more front elevation, one feels that there exists a mechanical resistance and one starts pains. When one makes the same maneuvre under , one sees the biceps which and remains trapped in the hinge without being able to enter in the cable routing channel.

 

. : With the or as a MRI, the cap is normal?

. : Not, the long biceps out of sand glass is often associated with broad degenerative lesions of the cap, but one also finds some with caps or partial ruptures and in the . A out of sand glass also can on the internal bank of the cable routing channel because the hypertrophied tendon acts a little like a candle of dilation and enlarges the pulley at the entry of the cable routing channel. As always, when one seeks… one finds!

 

. : Gilles was consolidated in his choice to cut the bicepses, but the relief obtained is durable?

. : Yes. The section of the long portion of the pathological biceps is an operation which brings a real relief to the patients… and which is not expensive the social security! Often these patients do not sleep any more the night. They are also very handicapped in their daily life to eat, get dressed, be capped… Gilles was the first to propose the of the biceps, there is now more than 15 years. When we reported the first results to the into 89, one had been made a little fire above with tooth and nail! And it was similar with the Americans who discuss us still sometimes “biceps ”! It should be said that the Pope, Charles , repeated in each one of his sermons: “… the biceps should at all costs be preserved! …”. Nevertheless Gilles paid at the time of the exchange rate of Nice, results of the of the biceps with more than 10 years of retreat: there is no degradation of the result on the pain and the function. Radiologically, one observes a discrete acromio-humeral reduction in space and with the scanner an increase the lubricating infiltration in certain cases. It seems that the associated does not bring a benefit on the pain except when acromio-humeral space is preserved and that one deals with rupture isolated but nonreparable of the know-thorn-bush.

 

. : Why want to reintegrate the biceps under ? What does that bring?

. : I pushed thoroughly the technique of during one moment; thus it is true that I reintegrated some much but it still sometimes happens to me to make and I always told, and I repeat it, that the does not give a better symptomatic result that the . The always does not involve “the ball of the biceps” on the level of the arm, nor of cramps. The of the biceps under is only one therapeutic option additional which is interesting, in particular among still young and active patients. In the United States, certain surgeons do not make or more of the biceps because some of them were attacked in front of the courts because of the unaesthetic character of the ball to the arm! It is for that it is also interesting to know to make a biceps under ; it is necessary to have several cords with its arc. On the French Riviera, the patients, even old, are also increasingly demanding and I make readily a , because it became an intervention of routine in the service. One generally uses an interferential screw as for the but sometimes one uses anchors or then one makes a direct joining length
biceps with the ligament
humeral transverse.

 

. : What is nine on the prostheses?

. : Initially, it is confirmed that the shoulder prosthese improves the quality of the life. Even if that appears obvious, it were necessary nevertheless that somebody shows it! thus showed that it was important to evaluate our results objectively but also subjectively and that the opinion of the patient counts too!

 

. : Question always of topicality: does one need “” the ?

. : There is no certainty, but the recent analyzes clearly show an advantage with the total prostheses compared to the hemiarthroplasties, at least in the and the PR. Finally, the for unsealing of relate to less than 5% of the cases. For my part, I the quasi systematic of way, except in the fractures and some necrose beginners.

 

. : Did one arrive to an optimal drawing of ?

. : The convex on the osseous slope resist the mechanical stresses better a priori that the punts like showed it . On the other hand, I think that it of sliced there nothing between the keel and the studs. It is also necessary to compare what is comparable, all the keels are not equivalent: a trapezoidal keel has an excellent primary behavior in the bone, contrary to a triangular keel which tends to be expelled. It seems that one needs a technique of cementing optimized with a not very important layer of cement. Therefore the technique of compaction of spongy forwarded by Dominique is interesting.

 

. : You emptied of his spongy?

. : Not, but nevertheless recommended to empty the pillar of the scapula and the to have a cortical contact with cement.

 

. : What do you think of the success of the reversed prostheses?

. : The reversed prosthesis is a major stage of the prosthetic surgery of the shoulder, like were to it the anatomical prosthesis and the prosthesis fractures. It is necessary to pay homage to Paul who had engineering to transform into success a concept which had always failed hitherto. But I acknowledge that I am anxious: the success of the prosthesis reversed risk to be sullied by too broad and too pushed indications, which would be a pity! It should be said clearly: the reversed prosthesis does not constitute the processing of the ruptures of cap! It is necessary to hold this prosthesis with old patients, if possible of more than 70 years, which forward a pseudo-paralytic shoulder with true lesions, without cap of the rotators… and biceps. The fact that there exists an acromio-humeral pinching does not mean subacromial osteoarthritis. The fact that the patient forwards difficulties of raising the arm can be related to the pain. If the biceps is always present and if my clinical review lets me think that the pains and the functional impotence of the shoulder are in connection with a pathological biceps, I propose initially a epic. Functional impotence can also be in connection with a deficit of the external rotators… but, the reversed prosthesis does not give again external rotation! One should not especially let think of the surgeons having little experiment of the shoulder which the reversed prosthesis is the universal solution and which one can pose it in all the indications. There, there will be failures and we already started to see some… As always in surgery, the equation bad indication = poor result + complications is checked regularly. Especially, it should be realized that in the event of failure, there are few possibilities of surgical recovery and that often finishes in swinging shoulder…

 

. : Which is the place of the reversed prosthesis for you?

. : I pose between 70 and 100 shoulder prosthese a year and the reversed prosthesis accounts for 30% of my indications but it is especially because I do much prosthetic surgery of overhaul of the shoulder and that it is also a prosthesis of overhaul when all the other options were exhausted. But in the nonreparable lesions of the cap, I make 90% of palliative surgery under for 10% of reversed prosthesis… and still, it is practically never in first intention but on failures of cap already operated without possibility of iterative repair.

 

. : In do the arthropathies of the cap, you think that the under should relieve the patients sufficiently?

. : It is not that it would have, it is that it relieves them! In any case, it is my experiment. But attention at the end “arthropathy”… I repeat it, acromio-humeral pinching does not want to say osteoarthritis and conflict does not want to say pain! with its famous “syndrome of the conflict antéro-superior” brought much… but it also distorted the spirits. Indeed, the conflict antéro-superior is painful on the tendons… but when there is no more tendon for a long time and that the humeral head is articulated perfectly with the and the ligament , there is little or not reasons that is the cause of the pains. When the patients having massive and old lesions cap of the rotators put themselves to have badly day at the following day with the shoulder, there are schematically three possible diagnoses: 1) is, indeed it is true a “offset”, become and thus painful a little as a hip a long time tolerated well which is degraded one day, by loss of congruence… but it is not most frequent; 2) is, it is occurring one necroses osseous or an osteolysis and there, that is seen with the imagery, it is true “the ” of which is not very frequent either; 3) is finally, and it is the most frequent case, the shoulder starts to make suffer because there exist again pains of origin. And in this case, the only tendon which can be painful, it is that of the biceps. This is explained easily by what is called the “phenomenon of the buttonhole”. Progressively of the progressive rise of the humeral head through the buttonhole created by the lesion of the cap of the rotators, the tendon of the biceps is found imprisoned between the and the head and becomes pathological: it , tears, hypertrophies and is found trapped, or escapes forwards or to luxate itself. What I tell, it is quite simply the natural history of the lesions of the cap of the rotators… Nature makes the things well: it tries to transform the shoulder into a hip! … A “nudge in the right direction should just be given him” when this natural evolution is blocked. It is for that in these cases, I explain to the patients that they as opposed to what do not have a “rupture of the cap” one told them, but a “wear of the cap”, which they understand very well. It is then easy to explain to them why to repair the cap “ lace would amount wanting” and that their muscles of the cap became greasy and nonfunctional. They understand whereas one can relieve them, by withdrawing hinge the tendon of the biceps become pathological.

 

. : The manes of and …

. : It is necessary to return justice to them, the with open sky which they proposed was founded. This said, for me, the is often limited to a gesture on the long biceps. I do not make a debridement of the rupture of the cap itself and I do not make either a , or seldom. The can even be besides a dangerous gesture in the event of massive lesion of the cap with subacromial pinching because it can break the fragile functional balance of the shoulder. I saw in consultation of the patients who had lost in a final way the front elevation activates after a “simple ”, makes some too aggressive. In any case, when it is the painful and mechanical implication tendon of the long portion of the biceps which creates problem, the solution is simple: the resection of the intra-articular portion of the biceps is a gesture simple and effective, let us repeat it. To solve this problem with the reversed prosthesis, they is heavy and expensive. It is to caricature, as if one made a total prosthesis of the knee, instead of making a ! One can of course kill a fly with a bazooka but afterwards, one should not be astonished by the collateral negotiable instruments!!!

 

. : What do you think of the prostheses reversed in traumatology?

P.B.: I think that beyond 75-80 years, that can be justified to propose a prosthesis reversed for a fracture, but it is necessary nevertheless to be very careful… because as opposed to what one could think it is not an easy indication. It is even very difficult to regulate the voltage of the deltoid and the height of the prosthesis in the fractures. The risk is prosthetic instability more especially as there exists the post-traumatic low phisical condition of the deltoid which, it also, supports instability. The other risk is the infection because the hardware is bulky and is found quickly under the skin… especially in the event of luxation. I already saw catastrophes with luxations of reversed prostheses put for fractures, multi-operated and infected. But in addition, the reversed prosthesis can be a recourse in certain after-effects of fracture where there is neither tuberosity no more, nor cap but I think that remains a difficult and specialized surgery.

 

. : Let us remain on the prostheses in traumatology: are you satisfies results of the stem ?

. : Yes, I think that the stem “fractures” was a real progress on the level of the possibilities of rebuilding of the humerus initially, on the radios which one obtained and then, on the functional results, even if it is true that the results also depend on the experiment of the operator. The problem is that this surgery is often made by surgeons juniors, delivered a little to themselves during the guards… It is for that the life should be facilitated to them! In fact, we amended several things. Firstly, the prosthesis was redrawn: it with a sagittal aileron (and either front-end processor) and less metal on the level of the coll It is better because that allows a better positioning of the tuberosities and that gives more chance of consolidation since one can add a bone grafting taken starting from the humeral head fractured to the level of the prosthetic window. Secondly, one improved and simplified the technique of synthesis of the tuberosities which is at the same time a lacing and a staying; and thirdly, there is the fact that rather than to put these prostheses in manner, one will tell, “”, one has today an instrumentation which makes it possible to stabilize the prosthesis during the operation and to adjust with precision the height and the prosthetic retroversion. For a long time, one tested temporarily the prosthetic stem with a compress wedged in the medullary canal and a day, I told myself that it was necessary that one has an external system of stabilization. It was the time of and I imagined that one leaves, as with an external fixer, with a hémi-ring in bottom who would be used as rapporteur, and in top, a tube with a graduated ruler which would maintain the prosthesis. I spoke about it in Gilles and it is as that which one developed the instrumentation “fractures”.

 

. : Did Gilles count much for your formation?

. : yes, I owe him my formation on the shoulder. I was internal in Nice in the service of Claude who was a department of traumatology and rachis. I made my thesis besides on the rachis with him and I liked the spine surgery much. The service received at the time much of large traumatology but very little csotcina.comedy and to really learn csotcina.comedy it was necessary that I make an external choice. I am thus installed to Lyon at Henri as intern inter-CHU. I worked much on the knee with , Philippe , and Pierre and I had the privilege to forward several work during famous “the Lyons Days of the knee”. With Gilles, one particularly sympathized. I started to write with him one or two papers, to re-examine patients, to make reviews of files, etc… At the time I wanted to make a diploma of thorough studies of surgery, but I sought a concrete subject. I went to see Gilles and I proposed to him to work on the shoulder prosthese because I thought that in 1988, one reached the same stage as the hip prosthese in 1968. I had the impression that there was to better do than the prosthesis of . In fact, I had re-examined all the prostheses of which it had operated and among these patients the good performances mixed with the bad ones without one being able to explain it well why. From there, I made a first study on the kinematics of the prosthesis of , and I reported myself that there were prostheses which functioned only in thethoracic one. In front of my proposal, Gilles asked for a time of reflection to me and its answer at the end of one week gave me. He told me that he was of agreement to work on a shoulder prosthesis but in the only condition which one finds innovating something of… if not one would do nothing. It is as that which the prosthesis was born: it was the first prosthesis known as “anatomical”. We posed the first two prostheses almost simultaneously in Nice and Lyon in September 1991. Afterwards, once the concept of this prosthesis validated, we have from the start desired to evaluate the results in a prospective way. We then joined together a certain number of friends surgeons who agreed to help us in this immense task. It is thanks to them, the famous group, that the results of two multicenter trials, bearing on more than 2000 operated patients, could be paid at the time of two congresses in 1996 and 2001.

 

. : Speak we a little Gilles ?

. : Gilles, it is an example for me. He belongs to the privileged meetings that one can have in the life and who make that your trajectory takes one day a different management and accelerates. When I made my six-month period of boarding school in Lyon, it was pH part-time job. It came two days per week to the hospital to consult and operate its shoulders in the square pulses which remained to him. I had already read all his items and I posed a heap of questions to him. And when him questions were asked, he answered… One day, it arrived with a pile of books on the shoulder, it was , the Casing , De , and it told me “Hold, lily that”. Me, small intern of passage, I was fascinated by this type which from the start trusted me, entrusted his books to me and encouraged me to work. Gilles has large capacities of work and moreover, it is a leader. What is remarkable, it is that it continued to have an enormous scientific activity while being in a liberal structure, which requires superhuman efforts. There are few people who managed to maintain such an activity scientific while being as a liberal. Today, it is a little my big brother! We continue to work together and I believe that we are rather complementary.

 

. : Let us return to your course; after do your meeting with , you re-enter to Nice?

. : Of course, I returned to Nice… but I also often set out again about it! Initially, because I continued to go up to Lyon regularly to work with Gilles and then, because I made two “” in the United States. In 89, I made first a nths stay in the USA with a purse of the during which I went to visit the great centers of shoulder surgery and the knee. I brought back besides to the of Nice the of knee under , which was not done yet much in France, even to Lyon. Thereafter, I had the chance to have a purse of the European Society of Shoulder surgery and Elbow and with Roger of London, we were the two first sent by the to the United States. I published besides a report of voyage into 94, in the 30 of csotcina.comedic Control. If I had only one consulting to give to young people, I would tell them “move you! ”. It is well to belong to a school, but it is capital to go to see what is done elsewhere… in France and abroad.

 

. : What did he think your owner of his pupil who did not stop going and coming?

. : With that occurred well. It brought to me much on the personal level, because it was impassioned by what it did and it was very open to the innovations; it had also a certain art of living. I make a point of paying homage to him because it is him which created of all parts hospital csotcina.comedy-Traumatology in Nice. Before his arrival, in 79 I believe, he had there only osseous traumatology which was still done in departments of general surgery. It individualized the speciality initially and then, it developed the spine surgery. At the beginning, it was traumatic rachis, then degenerative rachis. Its service it was a little “the potluck”, i.e. if one wanted to develop something, one could do it. Thus I could develop the and prosthetic surgery knee and shoulder. It prevented me at all, quite to the contrary. It is a great quality for an owner who to help his pupils to be made a territory. Thus a small of province could develop speciality of a and prosthetic surgery of the knee and shoulder whereas in other big cities of France, that was sometimes done with delay. For that, I would be always grateful to him. Sometimes, there were some shouts well what it tolerated badly my many return tickets in Lyon to continue my work on the anatomy and biomechanics of the shoulder like my participation in the days of the knee and the shoulder… But, it should be recognized that it had what to have the ! We remained very close even after its departure with the retreat and when it fell very sick I made it repatriate in the service where it “was petted” by its former nurses. It died out carefully an evening whereas Jean-Christmas, his son and me were with him in its room.

 

. : When did you decide to remain at the Hospital?

. : At the end of my , I went to see Mr. to tell him that I had finished and that I was going to have to install me. He told me “… you will be bored downtown, you are made to remain at the hospital! ”… and it found me a post of pH! It was the time, where one could still find posts! Thereafter, into 96, the service which had practically 100 beds was divided into two. I then followed it to the hospital of the Bow to develop the programmed csotcina.comedic surgery, and Fernand De , who is aggregate of Anatomy, continued to deal with traumatology on the Saint-Roch Hospital. I then passed Aggregation and I became departmental manager at the beginning of Mr. to the retreat, into 99. As there is not urgently at the hospital of the Bow, my service takes the guards at the Saint-Roch hospital. We developed guidelines of operation with and that occurs very well. In fact, the loop is looping itself since a new hospital Pasteur 2 should be built soon on a third site and that the two current services should be joined together again soon in a great department, with also the hand surgery and the rheumatology.

 

. : How is distributed your surgical activity in the service?

. : Approximately, we have 20% of rachis, perfectly dealt with by Etienne who developed all modern technologies of , 30% of general csotcina.comedy, knees and hips operated by me and my collaborators, in particular by Christophe , and of course, 50% of shoulder surgery. I also developed the tumoral surgery with the anti-cancer center and the ostéo-articular infectious surgery with the service of . That represents an important activity besides since we drain a good part of the infected prostheses of the area.

 

. : Why have chosen the csotcina.comedic surgery!

. : With a grandfather carpenter and a father butcher, did I have the choice? …

. : From the start, my ambition was to make an international, high level exchange rate of them. Therefore it is in English, although one is in France. Besides that made to certain French who have evil to understand certain questions or certain interventions. But unfortunately, if one wants to really make an exchange rate of European or worldwide level, it should be done in English. There are as many foreigners why? … I think that there is a real request on the shoulder surgery in general. This year, one received 250 surgeons come from 26 different countries, of which very remote countries like Australia, , Japan, Saudi Arabia, Nicaragua, Norway… It is pleasant which all these people .