. : How was your participation in the organized?
: Patrick O' who was the chairman of the congress this year me contacted two years ago and proposed to me to direct a Symposium on the Prostheses of the Knee for the 2002 which was held in Beaune. He is Chef of the department of csotcina.comaedics of the Hospital of Beaune. We work with less than ilometers one of the other but we did not know each other. I readily accepted for two reasons. First is that this subject impassions me since my beginnings and accounts for 80% of my activity. Second is that I felt very touched that a colleague hospital surgeon, takes the initiative to ask a surgeon of private, so near geographically and thus theoretically competitor, to deal with this task. It was for me a mark of regard and Patrick, who became a friend, the mark of a large open-minded. Moreover, the project seemed simple and without large stresses since all was going to occur close to at home. But, in fact, I believe that it is the meeting for which I worked the most in my life, because the project very quickly changed.

. : For which reasons?
: My friend Philippe of Lyon had met Gilles of New York at the end of 2000 at the time of an inspection common to Florence at . They had projected to organize the arrival of surgeons of Club in France at the beginning of the summer 2002. Philippe asked to me whether I could provide for a stage in Burgundy, and even to deal with the whole of the project. I immediately thought that it would be interesting to couple this inspection with the . I spoke about that in Patrick O' and with the Instructor (Chairman of the ) which immediately were enthusiastic and gave me freehand for that. At the beginning, one thought that there would be at most 5 or 6 American surgeons who would come, the more so as the organization really started just after the terrible events of September 11th, 2001. But, in spite of that, our American colleagues massively answered since 24 of them made displacement, and not small templates: Gilles of course but also , , Bob , Refusals, to quote only these. The things then took a considerable dimension not only for me but also for Patrick and the of which the number of participants, usually around 80, passed to nearly 400 registered voters!. Patrick thus had enormously work but, n the other hand, the reward to have organized the largest meeting of the history of the concretized by Romanian CD of the communications which it personally carried out!

. : It is what, Club?
: It is the club of the former students of John and the current organizer is Gilles . Except for some rare Europeans of which, Philippe and myself, make from now on left, the members are in majority American. All are specialists in the Prosthesis of the Knee and very attached to the memory of John . It is for me very an great honor to belong to this group and a very important event that Club came to Burgundy. I had worked at John for nths in 1982 and, just after my passage at his place, it came in the Fort. He knew the Private clinic well because it had posed the first Prosthesis Total there in France at the end of the Seventies. That had been done thanks to the invitation of a colleague, unfortunately missing, who was called Pierre . I knew it little but I know that it was a marvellous type, a jovial fellow. Concurrently to its activities of surgeon, it was also an artist able to play of the jazz like a pro. Thanks to him, had fasteners with and did not miss an occasion to come to taste with the charms of Burgundy each time it went to France with his wife.

. : How did you find yourselves in the Fort?
: I settled there in 1985 after several replacements. I sought a place where I could exert my art as I did it in Lyon but without having the stresses of waiting of a possible hospital post. At the time where I decided, my owner Henri was still young and it had as close collaborator Pierre . For my generation of pupils of , it was not conceivable to replace Pierre if it were not appointed. Besides after a series of replacements I thus made my decision by keeping me to say where I went.

. : Which were the criteria of your decision?
: I was before accustomed to making replacements at in Montbeliard under conditions, it should be recognized, enough testing. It was necessary to manage at the same time the Private clinic, the Hospital, plus a small Local hospital. There were permanently large urgencies to assume in different places what complicated still a little more the task. Because of this testing experiment, I arrived the first time at the Private clinic of with a certain apprehension and by asking to me whether I would be with the height because I knew that there was in the long term a possibility of installation. I arrive in a sophisticated Private clinic and I am accommodated by his founder: Bruno . He tells me “It is you who comes for the replacement? I will show you your room.” Splendid private clinic in the countryside, small #FFFFFF barrier around, and it specifies me: “especially if you see a patient to be operated you call me; you understand, it is necessary that I see how you make”. I thus made a replacement during the weekend of Christmas, under conditions which had nothing to do with those of Montbeliard where one called me on 4 telephones at the same time for urgencies. The following day, lunch in the restaurant of the doctors of the Private clinic with, inter alia, remainders of foie gras of the midnight supper of the patients. Burgundy what!

. : Was Bruno a Lyonese?
G.D.: Lyonese and former student of Albert , whereas, for my part, I was one of the last interns of . When I passed the boarding school into 76, I was in the ten first of the classification. At the time, only the first chose the surgery. The two colleagues candidates with the surgery who preceded me had made the co-operation, not me, I thus returned of the military service earlier than them. At the time of the first choice, I chose in first and I see that the last post of the service of is free. It was incredible for an intern of first year and I took it. In fact, the colleagues of fourth year and the others then had been let say that it was a post of functional rehabilitation, that going to take its retreat, part of its service was going to be closed for repair and that the last intern would have only very vaguely access to the block. In fact they was false, with the result that any young person, I was likely to attend , that I knew Henri and that even it was me which made the inspection of its private patients.

. : Which memories keep of your beginnings of csotcina.comedy at ?
: The memory of the meeting of Pierre and types “” which laughs which can make fun of themselves. It was a revelation because, for me, the surgeon was to be to trust, never to be wrong, and there I discovered people capable of . I liked this spirit there. I had been during a few internal months at the department of emergency surgical. And I must say that csotcina.comedy especially had then not attracted me. I had known only the emergency traumatology which was dealt with at the time by general surgeons. The interventions thus appeared long to me, not really regulated and random. At , I discovered the csotcina.comedy regulated with his Cartesian character. Conferences with the radios of control which one analyzed, of sometimes pitiless criticisms but which made progress. I was then converted with csotcina.comedy.

. : And ?
: I knew it for nths. It took to me in hand and I adored it. It was interdict in the service to tell him that I was in first year of boarding school. They was its last six months, and it did not have especially to be told him that the choice had dropped; I was thus judicious being already an experienced intern. The first day it entered the operating-room while telling me: “you are who you?” I answered “ Sir, your new intern” it tells me: “good, you attack, I arrive; it is necessary that I go up in my office to give a telephone call; you make the royal roads”. I turned towards the two instrumentalists; there was no surgeon to help me. The woman of Michel (former intern installed with Valence) which was at the time instrumentalist tried to explain me, but obviously I did not know. They called a chief who left another operating-room and who told me “go ahead I explain you”. That heated in my head, I hopelessly sought to remind me the anatomy of the knee and I made after a fashion the royal roads, but I stopped there, while remaining the two cross hands. entered and finished the intervention by making pretense play the game because it knew in fact very although I was in first year.

. : How did it install its Private clinic?
: settled in Chalon on the Saone in 1972 in a polyclinic and very quickly it had some will have because it had strong foundations in csotcina.comedy compared to the local surgeons who still made whole. It started to have important customers and it had some difficulties with his colleagues general surgeons who wanted to preserve csotcina.comedy and Traumatology. , it, militated for an exclusive exercise of csotcina.comedy. Vis-a-vis the refusal of its fellow-members, it thus planned to create a Private clinic Specialized in csotcina.comedy Traumatology. It was Mrs who was minister at the time and it had obtained the authorizations to start his project. Nobody would have bet on the success of such a firm at the time because csotcina.comedy was hardly recognized like a speciality. The other surgeons with whom he worked it finally put at the front door the opening of its private clinic with the Fort.

. : Not obvious to install a private clinic “ex nihilo”! Where did it find the money?
: At the time one could. His/her father was notary and helped it. His wife was doctor anesthetist and could assist it. It borrowed much, but it was a true contractor and it always believed that this project would succeed. At the beginning it joined half-half a Lyonese, but I believe that did not occur well between them. After a few months of common life, Bruno bought up his shares to him. Then, probably scalded, it took with him only Parisian Surgeons. Me, I was a little his way of again approaching the Lyons School by taking in his team a Lyonese.

. : There was already no badly world on your arrival?
: It is true that the 4 colleagues on the spot were strapping men, but I arrived at the moment when a tilting of the techniques was begun. There was the which required a true training and which gave an opening for people of my generation. With the , the route of the of the former crusader and prostheses of the knee were open. For surgeons already installed since 7-8 years all that was a little new even risky. In spite of their experiment, they feared the complications, the stiffnesses, the instruments which break and, rightly, to engage in techniques learned on the heap. At that time the alternative - existed and, many which was those thought that it was better a good sure meniscectomy by a small that a hard and imperfect , even aggressive for the cartilage. They needed somebody who technically can assume. And me I for that. had believed in the future of csotcina.comedy as a speciality and me I believed in the future of the in csotcina.comedy. The forecast of the patients whom we discuss is not vital but rather functional. The least that we owe them is to have a great technical skill that only, my opinion, the allows.

. : And the hospital?
: With my return of New York in July 1982, where I had spent nths as an intern #D1FFFF medal I initially finished my boarding school then I was appointed Senior registrar in the service of Henri in October 82. Henri and Pierre had formulated the project of a group of study on Knee prostheses: group . Because of the experience gained at John they proposed to me to be at their side. One regularly saw all the three at the time of the working sessions on this subject. Of this fact I had a special place among the Senior registrars of the service during the two years of which followed. Henri probably regarded me as somebody of shy person and it was surprised when I announced my intention to him to leave the service to install me, the more so as we were three on the four Chiefs to be left almost at the same time. The day when I told him that I wanted to install and take one day per week to me to return to me to Burgundy and to start customers, while finishing my it answered me curtly “if you want from to go away, you have to only leave immediately!”. Eight days afterwards, whereas I was on vacation, I receive a letter where he tells me: “Gerard, forgives my reaction of the other day. You understand, it is very hard when one sees his chiefs leaving; you belong to those which I like, one trusts you; tell although for us, Department heads, it is an anguish to see leaving people in whom one has confidence and that shocked me a little that you leave but you must live your life, I understand that you wish to leave, all my wishes accompany you”. Henri whom one regarded all as somebody of hard, showed by this letter a humanity that I did not know to him. I preciously keep this letter in my personal documents because that was the starting point of a great friendship interfered with regard and respect. If all its former students keep a great reconnaissance for teaching sound quality to him and the rigor that he taught us in our practice, much reproached him its sometimes rough character and then cut the links with the service. For my part I estimate to have been likely to discover this emotional aspect which it hid, undoubtedly by decency or, by fear that it does not seem a weakness.

. : Why to have created group ?
: It was a group made up around a project of Prosthesis but especially, initially of a project of . Historically one had passed by then by which had a hardware but which as prostheses did not go very well. With the Total, one found oneself with a prosthesis which worked but with a at the time rather rustic. To put a knee prosthesis that took two hours, sometimes more. We did not control all the smoothnesses. The step of the group that we had formed with Henri and Pierre , it was at the beginning to create a hardware adapted to the Total. Thereafter, when this was created, there was development of a new prosthesis whose specificity was the third condyle. We called it because they are initial Southern Lyon Hospital where we exerted.

. : From which does the idea come from the third condyle?
: We worked in collaboration with engineers of society. Our role was to validate the surgical feasibility of the mechanical solutions considered. The difficulty which arose then was the following: the prosthesis Total had a tibial pin of postéro-stabilization which operated very high in the notch a inter-condylar bar. At the time, there was no clinical retreat on this postéro-stabilized prosthesis and everyone feared the consequences on tibial sealing. The example that I often give is that of a force which is exerted on the engine pylon of a boat: with equal force, the negotiable instrument on the keel of the boat will be more important if the force is exerted with the point of the engine pylon that at its basis. For us, the solution to decrease the stresses, and thus the risk of potential tibial unsealing, it was to lower the contact point of postéro-stabilization in order to involve less negotiable instrument of pitch of the tibial keel of implantation. From where the third condyle. The other favors this proposal was to limit the size of the cage of . What I feared at the time it was that there can be conflicts with the ball joint in bending, that this third condyle which is an island does not pose problems with the patellar medallion.

. : How does your installation with evolve/move?
: Bruno passes the hand for all gradually to me that is knee. I.e. that I accept the play of a a little paternalist relation. My colleagues on the spot were older and they did not like too this relational mode with . In what relates to me there was a good difference in age, and we are of course. When he told to his patients you will be operated by my collaborator, in the spirit of all I were his assistant, but that did not disturb me at all. What counted for me to carry me out professionally. In addition there are covering joints of of the life which indicate to you that you are at the good place…

. : I.e.?
: My father had made party of the rebels of the war of 39-45 and he escaped 7 times from the camps of obligatory work in Germany. The 7th time it was made dent a skilled and it was dispatched in a camp of rectification in Poland, the camp of . It met over there a certain number of “hard to anneal”. One of them, Jean , will be later Préfet of #D1FFFF Coast then Chairman of the Administrative court of Lyon and administrator of the Civil hospices of Lyon. My father saved the life in dramatic circumstances to him and they were made this oath, with the life with death, that in the event of need the last survivor would help the family of the other. My father died when I was 7 years old. I was led several times to meet Jean and each time I saw it, he told me: ” Gerard, prove reliable by making a success of the contest of the Boarding school. Then, if you want to make a hospital career, I will help you “. But it was too not in my projects. Which was not my surprise when, at the time of a lunch with , this last told me the difficult conditions under which it had created the Private clinic of . At the time when the Private clinic was to open it had received a letter of the ministry saying that approval was finally refused to him. The Private clinic was built, lends to open. It thus called upon local personalities to be able to meet the Minister and to know at least holding them of such a catastrophic reversal for him and all the personnel. And at that time there, he tells me, the opening of the Private clinic I it must with two people, who allowed me to meet the Minister, explain my project, and rectify certain incorrect administrative data which made obstacle. First is André old resistant, appointed of the Saone and the Loire, and the second with which I owe a proud chandelle it is the Prefect Jean . I carried out this day there with much emotion that the loop was looped.

. : It had a hobby-horse, Bruno ?
: On the professional level, it was one faded prosthesis knee. He told me if you do not make any, you cannot settle as surgeon of the knee. He thus learned how to me to pose them with his manner, i.e. without , by a show of hands and as soon as he me had shown two or three times he told me here you understood. Thereafter, as it sometimes happened to me some times to be in technical difficulty, I thought that there was something to make as regards of Plain. I spoke about it in Henri , it told me “that does not interest me so much, you have only with you to occupy some”. Little time after Philippe came in the service to a conference, and Henri was interested so much by the way in which he spoke to him about Uni that two months after he convened me to ask me to take part in a project of .

. : Why make the Plain one since the Total one went so well?
: The patients suffered much after a Total Prosthesis from Knee and in the bilateral attacks, for a long time they did not speak any more theirs second side by fear of the operation. Concurrently to that, the prosthesis Linked such as Bruno i.e. by a channel initially of a little enlarged meniscectomy posed it, it was invasive mini surgery before the hour. Thus, when one installed in the same room a Total Prosthesis and Plain, the family of the Total Prosthesis regularly came to see us at the end of a few days by asking for explanations: why our relative suffers whereas the neighbor runs like a rabbit. It was an important argument at the time but which decreased much today. The Total Prostheses make less badly today because the techniques of anesthesia and postoperative analgesia are more effective. I do not think that our gestures are less aggressive but the continuations are dealt with better.

. : You thus put yourselves seriously to pose ?
: I had a very large period of installation of Prosthesis. But faithful to my Master Henri and the Lyons School, I thought that one cannot affirm without to have proven. I said to Bruno that I wished to re-examine his Plain with the proper perspective, because in Lyon one had the impression that this technique did not hold the route. He told me very well, in more you will be able to forward yourself to my patients and to make known yourself. I thus convoked again the patients, free. For the majority they went well, but there were also catastrophes. For the analysis of the failures I was likely enormous to have the complete radiographic file and, moreover, to have it in the minutes which followed my request because all was preserved in the files of the Private clinic and the personnel fantastically effective and available. That enabled me to discover a very at the time disputed mailman, that of the harmful role of the insufficiency of the Former Cruciate. required systematically into preoperative profiles in charge. In fact there were the supports of profile and the preoperative former subluxations and their postoperative repetition were seen. At , one had worked on this subject and one had studied just before I leave the service the natural history of former chronic laxities. It had been shown that involved a former subluxation of the visible tibia radiologically. I thus could note that certain failures of were not related to banal wears but on preexistent former instabilities. I published my conclusions with the in 1986 and my small paper made scandal a little because the tenors of Plain had not seen that. Philippe in particular feared that these conclusions do not lead the colleagues not to make but Total Prostheses any more. But its clinical good sense very quickly led it to recognize that the best argument in favor of Plain was the success of the intervention which passes by a good indication. However, indeed, if one does not want to have bad surprise with a , it is necessary to be very restrictive on the matter; I with 20% of osteoarthritides at the maximum.

. : At the same time how did the evolve/move?
: Completely well. I was in a group which defended the stabilization whereas much made the choice of the conservation of the CP. At the end of two years we were reassured by the options which we had taken with the third condyle. None the dreaded mechanical problems occurred. We appreciated much the co-operation with the engineers of Society. Alain itself in addition to his role of chairman has a technical training of the problems from his training of engineer and directly invested itself in our work. What I appreciated personally much it is the simplicity of the relations. In the event of problem on a technical solution the decisions were collegial and fast what was not at all the case for the colleagues who worked with alien companies. Today with 18 years of retreat, we are completely at ease. The third condyle proved reliable of harmlessness and effectiveness. Group was enlarged with the arrival of Philippe initially then Thierry what shows that the Lyoneses are not sectarian! More recently David and Michel joined us. The projects abound.

. : And the mobile plate?
: One took the turn of the Prosthesis with Mobile Plate 4 years ago. But with only rotatory mobility because, for us, the translation is an error. It causes a paradoxical movement which requests the aircraft bungee cord. In what relates to me, I hoped that the clinical outcome would be better, that there would be softer movements but I have the impression that it is strictly the same thing. In practice that gives the operational advantage to be able to choose between several sizes of plates for the same condyle and, in addition, it seems, in the light of several recent mechanical studies, that the option prosthesis stabilized with rotatory mobility is one as regards wear more. We could increase the congruence of the drawing of the plate without losing the advantage of the stabilization by third condyle which, by the bearing of the condyle towards the back in bending, improves the power of the quadriceps. It is a basic difference compared to the systems of stabilization by tibial cam and, especially, compared to the rotatory components congruent which them does not allow this retreat.

. : You seem to say that few things changed in your practice into 18 years?
: Not, not completely. What changed the most it is the way of conduction the operational continuations. I put myself three years ago, to use a technique of a little different rehabilitation. I immediately place the knees operated in bending at the return of the surgical unit. They are on a cushion triangle with 90° of bending with their compression bandage and without splint. The following day they are brought back to 45°, and, the third day, in extension. Then I make them the war so that they do not put a small cushion under the knee because often they prefer to have a small bending. It is necessary to be vigilant so that this tendency does not lead to .

. : Is the closing of the access also done in bending?
: Yes, always. I also changed in a determining way my channel initially. I make a channel , through the vast intern with the manner of and I note a faster recovery of stability in support . The patients give up their canes more quickly than when I made channels through the tendon between the former right and the vast one. I know that my colleagues of the group are not all of agreement with that but, for me, it is really very Net. While speaking about change, for one year, we have amended the casing of femoral prosthesis, in particular in the drawing of the throat . With the result that it is likely to adapt to the absence of patellar patching. I was rather reticent on this option and I thought that it would not be me which would test the first. And, finally, I was undoubtedly that which launched out most quickly there inside. After some timid tests I chose not to put a patellar medallion and the result was spectacular as regards speed of recovery. There is less of former pains and, in two months, the patients seem to have same enthusiasm and the same reconnaissance as those operated of hip prosthese. On the long run it should be seen whether we will not have fémoro-patellar conflicts. At nths of retreat, on more than 300 cases, I did not have to regret of main drawback. I took again only one patient for secondary patellar patching. What I like it is the enthusiasm of the patients, their impression of a knee closer to the normal. I really believe that the ball joint is a very significant area of the knee and less one touches people best there go. With condition of course that the prosthetic drawing is adapted what is the case for this new drawing that we called “” what wants to tell “ideal” in Greek! We thus gave up our traditional name but without to amend the major options: the stabilization by the third condyle and the command of the cuts.

. : What do you make as regards knee ?
: of the Kenneth-Jones type. With knee open at the beginning, then under the influence of Pierre , . entrusted to its sporting recruitment in particular footballers to me because, on the consultings of Albert who knew Guy Roux well, it had dealt with the follow-up of the players of the Auxerre of which it gradually forwarded the charge to me. I even specialized in the goalkeepers, whereas Pierre acquired his fame in the ski!

. : Do you think that the surgery of the sportsman of competition must be different from that of the sportsman of leisure?
: A thing really defers, it is the time between the wound and the intervention. It is always very delicate to shift an intervention in the sportsman of competition. With regard to the cruciates there is a main risk of iterative wounds, with a possible aggravation with the terrible consequences. They are wounded very anxious because it is their work tools which are faulty. These knees, as one is sure that they should be operated, I think that one should not make them marinade. Now that it there with the MRI, they want a MRI to be assured the diagnosis, but when they say that they want to be operated immediately, it should be done.

. : Why did you choose the trade of surgeon?
: What attracted me in this discipline of medicine it is its technical side. It is there on a side reassuring of the repetitive gesture which can be learned and, beside that a share of potential innovation which leaves free court to the creative spirit for unceasingly improving our gestures. I would say that more one knows the technique more one can be detached some and let express this “artistic” slope of our practice, which avoids any monotony. I also have on this subject another anecdote. I had made all my primary schooling with the College of the Park
in Lyon. At that time there were also the small classes in this prestigious College. Unfortunately the year of 6° very badly occurred because I was undoubtedly disturbed by the disappearance of my Father. The Headmaster convened my mother and this told him: “Madam I believe that your son does not have any provision for intellectual studies. We cannot keep it in our establishment. I advise you to place it in an establishment where it is framed a little better and to direct it towards a manual formation”. I owe him finally much because my mother, upset, actually registered me in a boarding school: the College of the Marist brothers of on the Saone. I carried not only out there brilliant such learned studies but a morals and a philosophy which influenced all my life. Then the surgery is undoubtedly unconsciously to take the advice of the Headmaster! What attracted me I repeat it is the technical side of the trade. In addition in all my communications, I insist much more on the surgical astutenesss and the means of avoiding the failures which taught me my experiment that on the analysis of the curves of results.

. : Did your liberal installation allow you to carry out your community projects?
: Certainly better than if I had remained at the hospital. For me, that gave me independence. What was my larger fear it was precariousness. But I had unprecedented opportunity find me in the Fort with a team of colleagues who supported my inclinations to publish and innovate. By doing this, I could at the same time carry me out and contribute to famous of the establishment in which I work. I was very proud to be at the instigation of Henri , deputy manager of the Symposium of the on the Prostheses with Philippe . My greater happiness it is also to have been able to do it while lowering my handicap of golf of 1 point. What moreover delights me, it is to be able to undertake these activities while having excellent relations with those with which I work and who express me no jealousy. It seems to me that in the hospitals it often wants there great to make well but which is sometimes barred for reasons for career. I never had this problem.