. : Why a congress on cement?

. : To answer our own interrogations and to correct our own insufficiencies and to allow each one to put in perspective itself but without for that falling on the conventional opposition between cement or not-cement. More simply to remake the point on the current use of cement above all on the level of the hip but also on the level of the other hinges. Is one certain to choose good cement? Is selected cement well used? What to expect some in the future?

 

. : he as well of things as one is unaware of on cement?

. : Initially, it is necessary to redefine the term of cement. In its current csotcina.comedic acceptance, it is a formed chemical body of two main components with a polymerization which is used for fixing of an implant. But beside cement “fixing” there is cement “filling”. And other functions of cement make that this concept evolves/moves… All that largely justifies a congress.

 

. : Which are your main interrogations on cement?

. : Above all, the question which arises, is: does cement have demerit? Is it moved into 2003 to continue to make a blind confidence with cement? Other questions follow: is cement still perfectible? Can it even evolve/move in its composition, its modes of preparation, its conditions
of use? That it is fields or cement is also a medicine by addition of antibiotics or antimitotic… Then, that to think of the recent implementations of this cement? For example for the processing of the vertebral fractures. And finally there this prospect on cements and their implementations but can one is include them in the family of cements?

. : Are cements marketed?

. : Some are marketed. They are used as filling with the losses of substance but there can be more ambitious implementations. One can imagine the near future where the not-cemented prostheses will be posed with cement like adapter of volume.

 

. : Do the French csotcina.comedic surgeons cement suitably?

. : It would be moved to say if they cement well or badly because many theories are defended, layer fine or thick, continuous or discontinuous but I find that we place ourselves in a too distinct way, impassioned between and not . I believe that in addition we do not wonder enough about the couple implant cement. One cannot put any prosthesis with any cement. And to appreciate a good cementing, are we of agreement on the radiological criteria of a good cementing? And which is the good thickness of cement? One has in this field of the schools which are completely different. The problem is to have argued options: by putting a thicker layer or on the contrary finer, I am based on such reference and such experiment! And such option inevitably induces the choice of an implant and its size.

 

. : But the problems of cement were especially problems of salting out of particles and compatibility of biomaterials; more rarely of the problems of technique of cementing…

. : I am not agreement, it is necessary to point out the crusades which were carried out to make evolve/move the techniques of cementing even if currently the longer-term results leave reflect It is a little that the difficulty of the analysis, I believe that one was interested preferentially in certain mailmen more concretely and others are almost last under silence. Thus the conditions of preparation of cement, quite simply the temperature of the block, only are very seldom reported thus that its own conditions of use, in particular the respect of the phases of work and installation. There is to only discuss with the manufacturers to see the importance which they attach to these mailmen. How to be astonished that in our medical literature one finds contradictory results. Thus cementing first and second manner were not studied equally in time nor with the same implants. On the other hand there were studies on the mechanical characteristics of cement with or without darkening agents or antibiotics. Because of the multiplicity of the parameters, I understand that one can lead to very different designs.

 

. : How does cement” for the go the option today “?

. : It varies, certainly, according to the articular localizations and the countries, but I believe that the medical bulletin is good and that it is still there for many years. When one sees the results of the prostheses of the type or other at 20 years 25 years, even established at subjects of less than 40 years one can think that this option does not have demerit. On another side certain uncemented prostheses which arrive at 15 years continue to give any satisfaction. It is true that the choice is a little difficult but it should not be Manichean. According to a more or less argued personal conviction each one has too tendency, I already said it, to become or exclusive . I do not think that one can blame one or the other through the results. Finally there are not two options which clash, but which must be complementary.

 

. : But which are the disadvantages of cement?

. : I am badly placed to speak about it since I remained but I do not see any him much besides that to add a problem of additional biocompatibility. The question is in fact that of its “ageing”, of its fatigue strength it is before only one of stresses and the problem isn't that of the conditions of the bone which changes around him? Thus I evolved/moved on the level of the recoveries, with a step which is skewed. I, in this , preferentially became not because I adopted the channel initially which allows an easy removal; and that influenced by the promoters of the access , I did not cement any more without the cemented recoveries disappointing me. One knows very well by the experiment of the femoral fractures about cemented prostheses that those Ci consolidate very well after a cemented reimplantation, if one pays attention not to leave cement in the line spaces .

 

. : You cement since how long?

. : I always cemented. I began my into 80 and for 20 years I have cemented quasi exclusively on the level of the femoral stems of first intention like on the level of of recovery. I used Simplex during very a long time.

 

. : You re-examine operated your ?

. : Of course, but the circle is restricted. But fortunately do the recoveries for aseptic unsealing become rarer and none resembles another and often, besides some faults obvious, I wonder but which is the culprit the implant, the bone, cement, the operator?

 

. : Thus cement to which you are faithful, it is the same one as 20 years ago.

. : Not exclusively, because it is necessary to be able to have a range of cements to adapt according to the case to discuss and it is one of the reasons of this congress; to have a reflection argued on the question: how is it necessary that I choose my cement? Because there is no answer univocal and same sometimes it is necessary to know to give up cementing. One of my centers of is represented by the prosthesis of ankle. In this situation there it is completely shown with the use that fixing without cement on the level of the tibial rammer is higher than fixing with cement.

 

. : Why?

. : We used the same implant cemented and not-cemented and it is completely clear: there are better results with the model without-cement. Probably because on the level of the tibial rammer, one has a completely limited surface and a cortical thickness. In front of the concentration of the stresses with time the cemented prosthesis with which there is no bone regeneration ends up being inserted. Our experiment confirms what Pappas had found 10 years ago, i.e. which to have an uncemented keel gives the best results. On the level of the shoulder the also poses corresponding problems because of the small surface of anchoring, but of the different mechanical conditions…

 

. : How was the Bordelaise school organized?

. : If too old times are excluded but without forgetting Mr Rocher who played an important role in the use of the central-medullary , the modern common denominator were Mr , then there were Mr , and other side Mr which took part both in the rise of the . Both cemented their prostheses. Mr leant side of , while the designs of were implemented opposite in particular by my direct Master the Instructor Rebelling It. I will not point out to you the development of the spinal surgery with Jacques .

 

. : What did it leave there with time?

. : On our premises, with of first generation to tail short “banana” and with the long stems, , the results were honourable, on the other hand, then with the stem” punt “of the undoubtedly because of distribution of cement that was less happy. Another variety of titanium also was at the origin of unsealing between 5 and 10 years. There was the problem of titanium with a grained surface quality and a supposed negotiable instrument “” of polymers to support cementing. Moreover one used heads 32, with the problems of volume of wear of polyethylene that supported.

 

. : After you passed to what?

. : I of course gave up head 32 and the for an anatomical prosthesis with a head 22,2 out of zircon with three lengths of neck what was rather rare at the time in but while remaining faithful to cementing. I chose the Crystal prosthesis which was clarification by the school of and . I had been the external one of Mr. and it had impressed me much. But I adhered to the couple plasma-ceram developed and used only secondarily the which is also employed for the prosthesis
of ankle service. Currently the couples sandwich polyethylene metal-metal or ceramics-ceramics are also used.

 

. : About what is it?

. : For the It is about a layer of ceramics and carbon of a few microns, deposited on a stainless matrix. But there were problems of absorptivity which slowed down the development on the level of the hip.

 

. : How can one have as Maître when one is Bordelais?

. : Because one with fact
its studies of medicine in Limoges.

 

. : Why Limoges?

. : It is very simple! Here is the history: I am Parisian, I made all my humanities in Paris to the vat with the college Henri IV that of which I remain very noble. At the time of the vat my father who was official was appointed in in the Hollow one. I told myself that the umbilical cord had to be cut carefully and I went to spend one year of to Limoges in 1968, with the idea to go up on Paris. Finally I tasted with charm life of province and I rained myself much there and I did not want to live any more in Paris. I thus remained in Limoges, the conditions of study were ideal in what was yet only one medical school and we had hospital responsibilities as of the first year for crossed . Happy time without ! One was 270 at the beginning and the end of first year 100 until the end of the course. Then I passed the boarding school to Limoges but my future wife had been received in Bordeaux. I to succeed in Bordeaux what was made after a one year stay in peripheral hospital with Tulle or I definitively took taste with the surgery.

 

. : How did you know ?

. : During my in Limoges. It had marked me much by its teaching, its imposing presence and its moral elegance. It represented really the Owner. But he did not know me more than one hospital student. However the mother of my wife was in Limoges, and having learned my departure in Bordeaux it required my news nicely of him. Later, it was very smart with me.

 

. : It was already an csotcina.comedist?

. : Yes he was the creator of csotcina.comedy in Limoges. He had been in Mayo in the Fifties and knew to combine the influences of the Parisian universities of the time. Its hospital was very subtle. For example, this anecdote. It made the consultation with an intern very extrovert, excel imitator but which this day there, made tons of them. was aggravated a little but the intern was unchained. Then it has ruffled a sheet of paper and intentionally threw it to the foot of a wastepaper basket. Then he told to the intern: “can you put paper in the basket he-you-likes yourselves?” the calm one returned instantaneously.

 

. : Which was your course of intern?

. : I started with one six-month period of reanimation because there were not enough posts of surgery, but by this skew I could enter in room of COp. Then I spent one year fabulous of military service to Madagascar. There was no more French Army but in the cooperation agreements, it was necessary that there remains a French military hospital to ensure the care of the families which had remained with the arsenal of . On my return I made obstetrics, gynecologist except with during one year. Finally I could make csotcina.comedy in at Rebelling It which had just had its service and which converted me with csotcina.comedy. The boarding school stays that 4 years also I supplemented my course of a #D1FFFF medal. A little also because I did not have a post of head in the tread… I made nths of rachis at and nths of infantile at . This last training course counted also much.

 

. : Why?

. : It is not the speciality which marked me, it is the man. Previously I had known only very hierarchical hospital reports. For me had professional and human qualities exceptional. The staff of the morning was with its image: a mixture of rigor and equal mood. When there was a patient to begin again it told: “you will take it again but I will take it again with you, and it is me which would see the family”. It was demanding but it could listen. The discipline which reigned in its service was not a problem because it was intransigent with itself the whole with a certain frankness. I remember of a bilateral intervention where he had promised to help me for the second side. It finishes the first side with 14:15 whereas it had a consultation after midday. I tell him: “Sir, you Listen to did not eat and you have the consultation, go ahead! Me I have some for one hour and you for inutes. He answered me: “not I told you that I will help you to do it”.

 

. : Thus you finish the #D1FFFF medal and you return to Bordeaux…

. : Yes to carry out my at Rebelling It since at the time there were four csotcina.comedic departments adult in Bordeaux.

 

. : How long did you remain?

. : My lasted three years and after I was appointed pH.

 

. : Why did it keep you like pH?

. : I am tempted to say because I encrusted myself, not quite simply because I am of course with my owner and that I answered the request! The CHU de Bordeaux has with Toulouse one of the two public schools
of chiropody-podology of France. My owner had been appointed Director of this school. At the beginning of my , it sent to me over there while telling me it is necessary that you will make consultations there and you will develop the surgery of the foot in the service. I thus made all my while not juggling too badly with this guideline which, at the time did not have the development and the consideration current and I think that it is one of the reasons for which it kept me.

 

. : It even propelled you…

. : Yes, I am grateful to him but that was hard. I had gradually met all the conditions necessary and I had become impossible to circumvent. then helped me much. It had opened one year to me before the gate of the information center of the . At the beginning it was a bibliographical coterie creates by which was put at the service of the community by carrying out the hard-bound cards of bibliography. It was a charge because at the time the meetings took place once a month Sunday evening with 18:30. I travelled by the landing gear with 14:00 in Bordeaux and one worked until 23:30, in the buildings of the . I had the chance to have the landing gear of the persons on leave which re-entered at midnight and I arrived to 3:15 to Bordeaux. I was not in an Olympic form Monday morning with staff. That gave me the advantage of mixing with the large old ones, of being able to profit from their experiment and their comments. It is priceless when one feels a little isolated but it is a heavy workload. Now, fortunately it is Friday evening. There are no more hard-bound cards but pages in the and the analyzes are reproduced on the site of the .

. : Which are your specialities?

. : I thus did much surgery of ankle and the foot, of the surgery of the sport but gradually I centred myself on the hip and the knee. I invested myself in the use of the and the osseous what led to the creation of the with , , , , . I stopped the surgery of the sport which however I liked much and which had gotten much satisfaction to me because the hospital system in its rigidity does not lend itself at all to the requirements sportsmen of competition. That became . Negotiable instrument of the age or the conditions of hospital exercise, I turn more and more towards faculty.

 

. : I.e.?

. : I am responsible, for the third cycle, of the surgical specialities. Bordeaux is one of rare faculties to impose a flow on the level of the posts of specialities for the interns and it is rather demanding. In addition, our FAC is traditionally turned towards overseas and engaged of the education acts or of aid and I am implied in a certain number of programs in particular one which particularly holds me with core,
in Kampuchea. In fact I have two sectors where I imply myself directly, it is Kampuchea and Mauritius.

 

. : Why Maurice since it is not Tom?

. : The FAC of Bordeaux, deals of the interned trainees with the Meeting and their teaching. Thus five times a year there are a “missionary” who to St-Denis will make teaching with St-Pierrre. The circuit understands a hook by Maurice, to do a little postgraduate formation. There are 7 or 8 years, at the request of the department of health of Mauritius, we created a , and formed of the anesthetists . In the prolongation of this program, a request related to three specialities: csotcina.comedic surgery, pediatry and IM. This formation is in hand and it is me which am in charge of csotcina.comedy. To answer your question, Mauritius historically has a double reference to France and with England and the Mauritians are bilingual. But in the Eighties, England decided to put itself in withdrawal for political reasons. Thus, gradually France took again influence there and the French language and the references to the crop and the French thought progress to Mauritius.

 

. : And Kampuchea?

. : Faculty had been creates in into 64. When the Khmer Rouges arrived into 75, there were 425 doctors theses. Alas 380 were carried out for the period known as genocidary. Among the 21 instructors of faculty, 19 were killed. Both which survived were one in training course in France, the other in congress in the United States. Later, when the things re-entered in the order, they succeeded in obtaining their Vietnamese liberators that the exchange rates continue to be exempted in French what always currently endures. In front of this attachment,
we have moral obligations. There exists a Kampuchean Society of csotcina.comedy which has been just created and which should be helped. decided to invite to its next congress the chairman of Kampuchean Society and to appoint it associated member.

 

. : What do you think of the exchanges with the countries in the process of development?

. : I believe that it is necessary to be careful. It is necessary to be wary of the individual initiatives without a future and ideally the interventions should be done in a coordinated way holding account of the local possibilities and go at the speed of the country. It is necessary to help
without being sharp with. However today one is taken between two extremes with people who do not have anything on the spot or if little but which has powerful information means through Internet and which see all that can be done. The can be large especially for those which return from training courses. In practice they should initially be helped on the level of traumatology then on the level of the csotcina.comedy whose dominant pathologies do not correspond inevitably so that we usually meet in France and to fit especially in continuity.

 

. : Does this passion for the humanitarian translate a lassitude towards the healthcare system into France?

. : In a direction yes! But in my opinion it is not a question truly of humanitarian but of teaching co-operation what is different. When I go over there it is a cure of youth which gives again with teaching all its dimension. That made of the good. But I make feel guilty sometimes because I have the impression to give little and to receive much. To return to France it is necessary to keep in mind all the wealth and the potentiality of our health-care system, but one is at the end of a cycle and it is necessary to see higher than the satisfaction of claims. It is necessary to leave ambient pessimism and to carry out the exciting task which falls to us to completely reconsider but also an organization educational system of the care.

 

. : Let us return on your subjects of predilection?

. : Separately the and the prosthesis and maintaining the endoscopy extra-articular on the level of ankle and the foot which occupy me much, I invested in the prosthetic surgery and especially the surgery computer-assisted. I am very attracted by the prospects for the robotized surgery.

 

. : You of made?

. : Yes, for the navigation systems we have systems and for knee prostheses. With regard to the robotized surgery, it is certainly necessary to cross the pitch but this can be considered only with the financial aid of the Area. My wish is to federate the possibilities of faculty and those of the local aircraft industry which is very open to a medical diversification and can bring to us. Some ten years ago, I worked with the large industrialists of the area on holography and especially the prostheses out of carbon and we had launched a series of clinical trials. But it finally fell water because the industry of the military aeronautics which financed the project fell in budgetary restriction.

. : Was the concept of carbon prosthesis valid?

. : With my opinion, the concept is completely relevant. We always follow some prostheses cemented out of carbon which always hold out 15 years afterwards. On the other hand, the uncemented carbon prostheses posed were failures for an obvious error on the surface quality which had undergone a pyrolysis.

 

. : There is evil to understand the advantage of a robot to pass from the graters in a femoral diaphysis…

. : For the moment one judges a first generation which poses conventional implants with a conventional access. But the true advantage of the robot will be to make a success of a minimally invasive surgery with specific implants. In addition, the navigation systems allow very an greater accuracy of sighting but if a conventional hardware of cut is used one loses part of this advantage. The coupling of both will be truly powerful.

 

. : Does summers satisfy you your experiment of Surgery Computer-assisted?

. : That made two or three years that I put myself there and I of it am very satisfied even if for the moment one does not save time. But the regularity of the results and the teaching interest are undeniable. It is a intellectual satisfaction and a practical asset and for the prostheses of the knee, I cannot to any more pass some me. For robotics with regard to the usual prostheses one will know only in 20 years if the prostheses put using a robotized instrumentation have a better durability. On the other hand, there is an honorable field from the start and which can support their opening it is that of the recoveries or the possibilities of a minimized access would have an immediate economic translation.

 

. : To conclude, let us return to cement. 30 years ago one wondered what would become the cement sleeve when the bone ages. Is there an answer today?

. : One can be reassured. Series show us that there can remain effective same with such a passing but the disparity of the results made well understand that the durability of a prosthesis did not lie in becoming to it cement alone but in that of the trio: implant-bone-cement and of its environmental conditions which it is necessary to know to analyze, to even amend. The heading of your question is revealing while pointing before all the ageing of the bone. All is not known as and the use of cement is always evolutionary. To retain only the main aspects: the debates on the viscosity and the reduction of porosity supposed to improve the behavior with fatigue of cement, are always open and in a way it practices is necessary to appreciate new cements and the techniques of preparation and cementing. I am persuaded that these Days of Bordeaux will make it possible to show that cement has more than ever a future.