One of the topics of Journées of csotcina.comedy of Fort de France was the surgery of resumption of the total prostheses of hip. The meeting was chaired by a Master who with intelligence and discretion, marked a whole period of the French csotcina.comedic surgery: Michel .

. : Mr , how are you?

: I am very well. The retreat, i.e. the departure of that goes back in October 1991. Immediately afterwards, I continued to work a little in private clinic but I did not find that very comfortable. When the records of the Public assistance was known…

. : What has you gene in work in private clinic?

: It was not to have of team and never not to be completely sure the morning while arriving that the prosthesis or the torque link would be ready. It was the fact of giving up the patients during the weekend. During the least absence the patient is private of his surgeon whereas when it is in a hospital team there is no problem. The stresses on the liberal surgery are severe and they are it still today than three years ago when I had this small activity. But in what relates to me, I believe that I had not organized myself. I was accustomed for a long time to an organization which went very well and a beautiful morning I was without anything. Knowing that it was provisional I did not smash myself to organize a team. A posteriori, I regret this two years strict private activity.

. : How that did it occur on the operational level?

: I was helped in general by an intern of , and my Jean-Marie son. There were thus people able to finish the intervention if I crumbled in the medium. I were not particularly tired, but although it is rare that a surgeon falls stiff during an intervention, it arrived, I know some.

. : Since you stopped any operational activity, how do you pass your retreat?

: I travel much, I will see my children on the right and on the left, I take lessons of golf, bridge etc…

. : You did not have leisures at the time where you were departmental manager?

: Not, because I spent my holidays is to ski, which I still make, is to fish at sea, which I still also make but they were not everyday activities.

. : You are not interested any more in csotcina.comedy?

: If; I am always present at the congress of the for example. I continued to occupy me of problem of hardware with and AFNOR. And I was nevertheless invited to a certain number of roundtables.

. : At did 5 years of your retreat, csotcina.comedy change much?

: Appreciably I believe. I am a little afraid in certain roundtables of this kind not to be not in my place. Types of prosthesis, fights between the and non, prevention of infection post-operative, processing of the septic lesions. I do not have the impression when I turn over Monday to for example to be completely in the race.

. : But precisely, for all the topics which you enumerated, one with the impression that nothing changed…

: Of course it is not very different, but I am perceived as being beside the movement.

. : For example, with regard to the debate cement-without cement what changed?

: I think of the hydroxyapatite. On the femur there are no notable changes the is fixed without cement in a great number of cases and apparently that does not go so badly. But it is surely not the panacea, especially as regards recovery.

. : Let us retrogress a little at the time where you were department head. One with the impression that during the ten last years of your activity one made only prosthesis with …

: There remained a small place for the osteotomies all the same. It related to the hip dysplasias and hip osteoarthritises on dysplasia with an early stage among still young people. One made or of .

. : Which balance-sheet do you make of ?

: I have the impression that it is a completely valid intervention. I was practically the only one to do them in the service because of their fast change, the chiefs on little the occasion to help some and even less to make some. These osteotomies were appropriate well for young people for whom the type of hip osteoarthritis returns the or without hope. It is a very good operation.

. : There would have been too much stop?

: The stops on and non hips one will never do too much of it. has almost the same indication as the stop but on a developed osteoarthritis and not by an femoral osteotomy.

. : The Bernoise school developed an osteotomy of rocker of , that do you think about it?

: They is surely good in good indications but it is too strong for me, too difficult. However, it is nevertheless a very heavy process for hips which will be never normal hips and which will finish with a prosthesis.

. : Precisely until which age is it necessary to push the indications of the preserving surgery?

: I would tell 50 years limiting last. It can be that this time is exceeded or on the contrary that it is too long but approximately one can have excellent results of butted up to 45 years.

. : But it is not if pain-killer that a stop. The access is rather important.

: Yes, it is necessary to know to make the stops on the points of the feet by repairing the muscles well. So many the poor women are seen which were made take down the tensor of the fascia latums and which have a large hole on the iliac crest. They is scandalous. A good stop does not change esthetic morphology if I then to tell. But the know-how of obstinate is lost a little. My successors do not do much of it.

. : Does that scandalize you that one pushes people with the prosthesis?

: That depends on the speed of the development of osteoarthritis. I believe that one should not too much cling to barriers. To affirm “You are not 50 years old you are not entitled to the prosthesis; you have 51 years have there you right” that appears ridiculous to me.

. : In you were nevertheless on the slope prosthesis.

: I believe that it is a question of recruitment. During very a long time we concentrated in all kinds of pathology of the hip. I speak one moved back time where it was done little outside. People came to consult us province for a dysplasia whereas now there are 150 csotcina.comedists only in Paris who are ready to jump above. It is the recruitment which changed and the training of the csotcina.comedists being this which is, the dysplasias are discussed on the spot.

. : Didn't that weigh you to always make the same operation?

: Of course the banal hip osteoarthritises centered well among normal sized people it is a little the routine but it is not unpleasant to make a good operation well. In addition, more one is dived in a speciality less one can make the remainder. I made not badly knee prostheses but I never really concentrated myself on the problem; they are the different one which advanced it and I did nothing but jump in the landing gear.

. : With regard to the , you solidified a little on …

: In general, when one holds a good intervention one does not want to change. Moreover, I was very scalded by my attempts at innovation. At the time of the prostheses metal-metal of we wanted to better do and we developed a metal with tapes with update. The idea was to decrease frictional resistance and in vitro it was infinitely higher than the couple usual metal-metal. But because of knowledge of the time, we had very badly evaluated the biological consequences of the remains of wear. The cobalt remains started among patients a monstrous reaction around the hips.

. : Which was your frame of mind at the beginning of the prostheses?

: We had fears of all kinds. One of the reasons which made us keep long enough it is the cavity which one created with . One removed a , famous person and a large neck and one replaced them by a small stem which was m in diameter. I.e. one left a cavity in which there could be only blood, and that least the passing by there… Another fear related to luxations and besides we had a certain number of it. There there is no discussion: if the small heads are favorable side of wear, they are unfavourable for the prevention of luxations.

. : Which are the reasons which made you amend ?

: One realized at the end of five to six years that there were depressions of the femoral parts in the femur. They were inserted in cement with a kind of fissure on the internal edge of the prosthesis. That accounted for 10 to 15% of the files. By amending the dimension of the tails and by filling best the femur with the prosthesis we eliminated one from the causes of failure.

. : Because of the university environment you could have evaluated several alternatives of prosthesis…

: It is true I recognize it, but each time a review of files was made the results of were the best. I believe that at one year the percentage of complete success of under normal conditions is of 99%. Then to begin another series by hoping that at the end of 10 years one will obtain 99,9% of success to the risk to less better make… They were perhaps not very courageous as attitude but it is necessary to think a little of the patients.

. : 25 years afterwards, which do you think of this couple so decried metal-polyethylene?

: It is easy to say evil of it. One much told and wrote against cement, but I believe that it is not responsible for large thing. When one looks closely, the so-called diseases of cement they are the diseases of the badly made prostheses. We always said that later, it is the wear of the polyethylene which would create the problem. Wear as an amendment of the cavity and a generator of polyethylene dust. We tried well with to make search on new materials. We had addressed to very qualified people of Arts and Métier which quickly sent us on the pinks by saying that from the wear resistance point of view of, to the abrasion and with these conditions of maneuverability, we would not find better.

. : Didn't the couple alumina-alumina, that try you?

: The alumina without cement appeared a heresy to me having little chance to hold. If that is cemented a little its interest loses. I regretted not having an alumina femoral head, but it was necessary to increase the diameter and to pass to 28, then…

. : What do you think of the current proposals for a return to metal-metal?

: I did not understand very well of what their amendment consists but it seems that the Swiss ones return to a prosthesis which failed on our premises and even on their premises. I love much Maurice but it is a little the perpetual change.

. : There is perhaps a happy medium?

: I nevertheless innovated in the service. With we introduced the osteotomy of …

. : How?

: came to a congress to Paris in 1952 and showed some radios which appeared to me. I was at this time, senior registrar with in the service. Fifteen days after we were in Aachen to see how it made. One spent three days of specific lessons “not-stop” and one brought back that to . It was an interesting acquisition.

. : Had blackbird of let to you leave?

: You imagine the Owner who has in his service only two chiefs and who gives them the authorization to leave together. But that occurred without problem and we left three days with Roger and Louis . In fact, at the time there were still and . Then with our return it left us freehand. For the total prosthesis that was a little similar. I received one day a telephone call of , an English csotcina.comedist who organized in London a remarkably made higher exchange rate. It was into 65. He says me you should come to Norwich, there is an interesting trick; you will see what they is that the total prostheses of hip. Then I spoke to the Owner about it, and went there we. It was a species of small English club in front of which had its results. There were patients convened with their radio and who walked without cane. operated two patients in front of us Sunday. Then we returned to Paris while asking him to come to pose two or three of them. It is as that which we started. Previously there were only prostheses of Moore. We had never seen a similar quality of results.

. : Blackbird of liked the English…

: Yes.

. : Why?

: Perhaps because of Watson-Jones. It was more the most international traveller and of the English; he was very brilliant. But there was which was remarkable. A reserved, careful quiet man and of great rigor; thing to which one was accustomed little in France at the time.

. : It was what the absence of rigor at the time?

: It was the absence of file, the absence of full review of the patient before operating. The results were always “very good”. Why? because they are very good! It was primary when one thinks of it. I believe that at present, one goes too far in the statistics, but there one did not make any at all, the observations were not taken, quantified quotation did not exist.

. : It is you who made this quantified quotation?

: I took part in it but it is not ego. I am always quoted but it is really an idea of Blackbird which had outlined it and forwarded to a Congress of the into 49-50. It then passed unperceived then two or three years after, in full period of acrylic prosthesis, American invites it to make a conference on the arthroplasties of hip which is then published in the “Maid Joint” with in board quantified quotations. It is me which had prepared the item which was signed Merle of and , but I am not the inventor of quotation.

. : How did you become the privileged collaborator of Blackbird of ?

: That occurred in a curious way. At the time one retained his four posts of intern for the four years of boarding school. I.e. that the shortly after the appointment to the contest it was necessary to sink among owners among whom one thought of having a place and this on the consultings of Pierre or Paul. In fact, it is which told me: “Will see Merle D' , it is not yet aggregate but that will come”. In first year of boarding school I fell on an special issue the Week from the Hospital entirely devoted to the Merle house. It is there that I discovered the serious one in the publications, the outline of quotation, the explanation of the quality of the results, their evaluation in frequency. For me, it was completely new. I had made plasters in the two departments of surgery or I had passed as internal but they was horrors, disgusting plasters. Whereas in Merle it was beautiful csotcina.comedy, the true one, made on examined patients. And the year of boarding school passed at his place did not disappoint me on the contrary. But there is also a question of hooked atoms. Obviously we understood ourselves well and I was one of only with being able to approach it the days of great anger.

. : You were colleague with …

: had six months more than me. We were appointed with the boarding school together and we disembarked together in the Merle service of in 1947. We understood ourselves very well. It was a force of nature from any point of view which it is the organization of a service, the organization of the photograph in the service or the organization of a roundtable on all that one will want. It was a glutton for work. I liked it much and our dream when we made the inspection together was to tell us “It would not be badly if one returned both here”. And that occurred.

. : In spite of did France almost deprived of csotcina.comedist, you dream to remain in the head office?

: Yes. Robert had relations more difficult than me with the Owner because it put the feet on the table and that it aggravated it by a certain ease in the presentation or the form. But it sank, it worked very quickly and its items were ready. When the Owner gave up the problems of foot which annoyed it, took them again in hand seriously with studies and results. And then arrived the day or the Owner left. There was the succession to take. One had pinned our small maneuvre and me so that it is appointed departmental manager. I a little with the Owner because he wanted that it is me and me I did not want, because I thought that had more the profile of the department head.

. : It is a a little unusual dispute.

: In fact conditions seldom reproduce. In practice, to have the certainty that returns in , the only solution it was that I do not move of my post and that to him is directly offered the place of Blackbird of . We were both at this time there, full professor at the same level.

. : Blackbird had all the same a rather aristocratic vision of the existence…

: Because of that, he was copiously hated by a good number of his colleagues. And moreover, it did not let pass large thing. When it had something to say to somebody it told it to him opposite and without taking glove. But he sought the brawl and it was a little a play. In addition it could not support that it is called “Blackbird” because in his medium one speaks about “Mr d' ” and not of Blackbird. One Leger day writes “My Dear Merle to him” and he answers him “My Dear Lé”.

. : It is him which gave to this currency Greek “the word is only the shade of the share”?

: Yes it is an aphorism of a Greek philosopher. I never knew in which direction it had it to be understood “That your speech is the reflection of your work” or “That your work is the reflection of your speech”. In the spirit of the Owner it is that the speeches on such operation are valid only if they are the shade of what was made. In other words the words must be in conformity with the acts.

. : Is the strong opposition between Blackbird of and it legend?

: Not it is not legend. They always remained gentlemen and that forever be to the street battles. The torts were very limited but the opposition on the consolidation of the fractures was clear and clear just as that on the manner of exerting our trade.

. : In was the content, where the difference?

: The Owner advanced with much prudence. At as soon as it had an idea, and God knows that it had some, it was immediately told, published.

. : You knew one time of permanent innovation as regards prosthetic arthroplasty…

: I had the impression that a certain number of colleagues dreamed the night with an amendment of existing prosthesis or a completely new idea and passed to the implementation the following day. This rate/rhythm there, a certain number of prostheses led to catastrophes. I have myself, in spite of some feasibility studies, makes a coarse error with the prosthesis with tapes . But it should be recalled that at the time the manufacturers were at the disposal of the surgeons. The body of the csotcina.comedists had something of dynamics, tonic and effective in search. It gradually sank in the grants of the manufacturers. A certain number of colleagues thus launched out in “anything” by amending a detail on a prosthesis for touching royalties.

. : Did you try to slow down certain heats?

: I tried to determine with the Commission of osteosynthesis of the of the quality standards of the hip prosthese but it was awfully difficult. Of which right can one decide on such or such criterion? And the economic approach is also problematic. By fixing a very low price at the prostheses one abolishes many repercussions interesting for serious laboratories and serious considerations.

. : What do you think of the continuations towards the surgeons for embezzlements?

: I believe that some deserve what fell to them above. Those which have “creates” prostheses which were a copy to which they added a comma to increase the price by them, to create judicious small firms “can” to buy prostheses with the manufacturer and to resell them by an intermediate which was their wife…

. : To return to fears which you had at the beginning of the prostheses, don't you fear the infections?

: If, we were convinced that it would be the major complication and this more especially as we were disarmed. There was then a principle: an infection on a foreign body ends in the obligatory ablation of the foreign body. told besides: “If the functional state of your operated future is higher than what would give a resection head and neck, leave the quiet one”. In the beginning one believed that one had escaped there because happily during the three or the first four years, there no was acute infection. In fact, one took a long time to interpret the radiological images of septic unsealing; it did not come from the first blow.

. : When the was essential?

: Enough late. We started by putting the patients at antibiotics but not good way, not before the intervention, not inevitably with good antibiotic. That spent a certain time to be elutriated. Then we made prophylactic too much heavy and long which probably induced resistances which we could have avoided differently. The infectious problems were immediately attached to the party of the service which was mine. had already started to work the infectious problems with the Owner.

. : Why?

: It was voluntary for a first survey into the post-operative infections which goes back to the Fifties. lived without anything to require, without having the honors of a whirring bond, nor the emoluments besides.

. : Perhaps he liked peace, he had his #FFFFFF tower.

: Yes that it defended with ferocity. It had sometimes a character of pig but as a whole it was really very pleasant to work with him. I immediately left him the flange on the neck, but I made an inspection at his place from time to time. Each time there was a problem he me spoke about it; it was the ideal collaborator.

. : However, it would have had reasons to be bitter…

: It cut down a fantastic work during 25 years without seeking the honors. It was officially attached in the service and enquiring CNRS. For all its rendered services, the Public assistance was very ungrateful. Five years before its retreat when one realized that he worked at CNRS and at the hospital one stated to me that he could not cumulate both and to keep all its vacations (that made 5000F approximately per month) and one obliged me to total three, then finally has to abolish them. He all the same continued to make its job, to hold its files with a terrible rigor, and to write interesting papers.

. : In what its approach of the processing of the infection did defer it from that of for example?

: Schematically, was less aggressive. He sought to initially obtain the consolidation and the termination of treatment of the infection came then. on an infected nonunion of the femur by removing all that was dirty and by removing the nail. For nothing in the world a chamber correctly synthesis would not have removed. Initially to ensure osseous continuity, then to drain the septic chamber….

. : Your service had a great radiation on Parisian csotcina.comedy. All the famous hips went in . Is there the right to speak about the fracture of the neck about Chirac?

: Yes I believe; the radios were shown with the press and one spoke about it everywhere. It was a banal subtrochanteric fracture.

. : Which kind of operated was it?

: Very simple, very easy to handle if I then to tell. Fortunately very happened well. The only difficulty was to resist the external pressures of people in search of details. But if there had been a pip in the development that would have been dramatic. I still reconsider, the day of his accident, with the troop which awaited it the pavillon. The ground floor of the urgencies was full as at the beautiful days with May 68. One awaited it for 18:00, with 20:00 it was still not there. Somebody challenges me and “I tell me am what it has and what you will make him?”. I answer him “But Mr I can nothing tell you I did not see it, I did not see his radios and I do not know anything him”. But, it, “it are necessary well that I speak and my tv news is with 20:00.” I tell him “Address you elsewhere”.

. : Do you regret after this long career devoted to csotcina.comedy?

: Yes it is not to have devoted enough time to teaching.

. : How did you can have taught more?

: By operating myself less and while helping more.

. : You have the impression not to have helped the young people enough?

: Yes. Not at the beginning, but gradually I let myself embark in the system with almost daily resumptions of prosthesis and which lasted all the morning. When one has just finished that, one does not have very to help an intern.

. : Nevertheless you had many faithful pupils?

: Yes and much became almost friends. What I appreciated more these are a staff which went well, where there were some original patients too simple pitches and with a state major of interns and chiefs who was interested in the problem.

. : Did you like what so much?

: Impression to render comprehensible with people who were there, the operational indication and the decision. Operational aid is important, but the decision-making aid is major.