Ten years ago, Gilles disappeared tragically and prematurely. This number of csotcina.comedic Control is a homage to its memory. The management of its service was entrusted to Michel Henry who since, did not spare his efforts to maintain the tradition of quality of csotcina.comedy inhabitant of Saint-Etienne. Michel Henry pleasantly agreed to refer to the conditions of his installation with Saint Etienne as well as the memory of his meetings with Gilles .

 

. : How was Gilles at the end of his career?

F.: It was not the end of its career; it still had beautiful businesss year in front of him. It disappeared tragically and too prematurely.

It was, I believe, before a whole keen worker. It is however difficult for me to refer to Gilles , because I am not his pupil. I never it in his professional daily newspaper. Its pupils are placed much better than me to speak about it.
My first meeting with Gilles goes back to 1991, date on which it belonged to the Jury of my thesis of medicine, that I had devoted to the femoral stem screwed that it had developed. At the time, that had been worth me some enmities of its share because I had said only good of this implant. This was however constructive, since at the bottom of itself, it knew that this stem did not have only advantages; it had amended it with many recoveries.

I knew also Gilles through the inspections which it made with my owner, Mr Fischer, with the pavillon T, in particular at the time of the annual meeting of the jury of the of csotcina.comedy, but also at the time of meetings and of conferences organized by the service; these meetings were always the purpose of profitable exchanges because of its promptness and its deep kindness.

I knew finally Gilles , through work meetings around a program which we in common had around the double mobility.

It really left me the image really of an untiring worker. One told me in the service that he worked of good morning until very late in the night. It took care on all the patients of the service. It validated all the indications. Gilles was a true legend of csotcina.comedy.

However, it would seem that in the last years of its life, csotcina.comedy was not any more its essential passion, he was devoted to its times wasted with painting… It is a breakage little known of this character out of the commun run.

. : What is what justified it?

F.: It was always in search of something again. Albert appointed 4 pupils: Henri , Paul , Jean Luc and Gilles . Gilles was to some extent the free electron of the team. He always had ideas, can be too much of ideas.
But in Lyon, it was moderated by the other team members. When it arrived at Saint Etienne, in 1974, it gave free exchange rate to all its ideas, which were fulgurating; alas, his/her Lyons friends and his/her colleagues, were not there any more, to bring a certain weighting.

. : Did he live his departure with Saint Etienne, like an exile?

F.: Not, certainly not, the more so as at the time, the service of Etienne Saint was attached to the of Lyon; the boarding school of Lyon included the services inhabitant of Saint-Etienne. All the interns specialists in guideline in Lyon passed to Gilles ; they preserved all of the memorable memories of their training course, as well on the surgical level, as for the surgical extra breakages of the life to the boarding school, with Etienne saint.

Later, Saint Etienne knew his range, with a separate choice of its interns; in my opinion, it is at this time there that Gilles was disappointed; the Lyons interns who, by tradition, chose it, did not come any more until Saint Etienne.

. : Was it authoritative?

F.: There still, it m `is difficult to answer. I think, very sincerely, according to what it could be to me told about it, that it was opened with a certain discussion during the analysis of the files. With final, however, it is him which made the decision.

With personal capacity, in connection with my thesis, even if it were not completely satisfied with what I had been able to write, one had been able to discuss it. Concurrently to that, any Department head must show authority, the Chief of school must give the line of conduct, and the discussion then, is not possible any more. All the pupils of Gilles were very touched by its disappearance; if the learned societies lost an innovative Master, the Lyons School of csotcina.comedy lost a Chief of undeniable yarn; its pupils really lost a father.

. : Which was the experiment of the screwed stem?

F.: There were successively three types of screwed stems. The first model is stem drawn in 1979; it is about a screwed stem on which is added a screwed modular neck. This stem had the disadvantage of generating with metal source of early unsealings of the cup. Sometimes, these lesions of are visible on radiography; indeed, there is a visible notch on the prosthetic neck. Stem is abandoned in 1981 because there exist consecutive ruptures of implants to the assembly of the parts. In 1981, the experiment begins from stem PF. It is about a screwed stem on which is installation a cast solid stainless base plate polished, the neck measures m, the head 22,isters the head is cast solid on this base plate. This implant will give compared to doubles mobility of excellent results. However, the appearance of the first cases of luxation prosthetic made evolve Gilles to a third model of screwed stem. In 1986 the experiment begins from the stem PRO. It is about a screwed stem on which is installation a Titanium base plate whose diameter of the neck is of isters On this Titane base plate is installation in way modular, a head of 22,2, of 26 or isters the experiment of this stem screwed in these various versions was essential and largely contributed to the rise of without cement in the Rhône Alpes area. The area Rhône Alpes, it is true played a central role in the advent of without cement in France. Many groups whose fame is clearly displayed, were born in Rhône Alpes. The ideas of Gilles , as of the years 1980, are undoubtedly at the origin of this regional development.

This stem was covered with a spray alumina. It acted at the time of a technological prowess; and then, behind this recovery alumina, there was the idea of a biological fixing which Gilles wished to seek; one knows today that this Alumina is not , contrary to other structures like the hydroxyapatite. However the technological process of the spray was elaborate as of these years there.

It should well be also recognized that this screwed stem contributed to show that it without cement was a reality. Admittedly, there were early underspeeds of these stems but when they obtained a secondary fixing, they had a perennial fixing. They had even the reputation to be ; it was finally the sought-after goal: the final fixing of the implant to the bone.

It is very often via this screwed stem that the surgical teams of the Rhône Alpes area arrived at without cement. With the pavillon T for example, Mr De began his experiment with without cement, in the prosthetic overhaul, by using the implants of Gilles , following the thesis of his pupil Doctor Jean Louis .

Lastly, if this stem were innovative and source of progress, it still introduced a concept essential with the mode today: modularity. This modularity made it possible to regulate the ; it made it possible to regulate lateralization; it made it possible to regulate the length of the coll.

It is an innovation suggested by Gilles , often forgotten.

. : How this screwed stem was perceived?

F.: As I tell it to you, at the time, this stem was a revolution which contributed to the rise of without cement. However, there were disadvantages. First prosthesis supported and involved unsealings . Stem PF forwarded a massive base plate source of trochanteric fracture. In my thesis of medicine, devoted under investigation screwed stem, I had been able to pay with these stems PF, 15% of fracture of the great trochanter; these fractures however were not always moved; they always did not require an osteosynthesis; but these trochanteric fractures caused potentially insufficiency of the average gluteus. In my thesis, with the model PRO, however less massive, I brought back 10% more of fractures of the great trochanter. These figures today would seem quite dramatic.

. : What is it reliability curve?

F.: The reliability curve of these screwed stems is not extraordinary. These stems were penalized by early underspeeds which penalized the reliability curve of course. However, it should well be admitted that once secondary fixing was ensured, this fixing became eternal. I see today many patients in the service who profited from such an arthroplasty. Sometimes, I take them again for problems , I must say that one does not change the stem which remains perfectly fixed. One is satisfied to change the modularity of the neck and the head. In addition, it should be recognized that it without cement is opposed in the passing particles since never, I do not see a granuloma with foreign body in end of stem with this stem screwed without cement.

. : You seem to forget the pains of thigh?

F.: Not, I do not forget them. It was about an essential problem with these screwed stems. The pains of thigh in my thesis are present in 10% of the cases. A certain number disappears during the first year, but some endure forever. These pains are undoubtedly the fact of a preferential diaphyseal fixing, even elective, in particular with the first models of stem. It is undoubtedly for this reason that the drawing of the thread cutting often changed with the yarn of time. Initially, the nets were trapezoidal, they became corrosive, they became then refined gradually base plate of the stem in end of stem. Little time before its death, Gilles tested a last model of screwed stem; it was about a metaphyseal stem, to precisely avoid this elective diaphyseal fixing. Gilles forever desired to recognize this major drawback of the screwed stem; however, the development which it gave to the profile of this implant was well the reconnaissance of the problem by the designer himself.

. : When did it develop the doubles mobility?

F.: The first work on double mobility begins in 1976. At the time, really it is not a question of the double mobility to the direction where it today is understood; indeed, at the time, it is about a retentive polyethylene set up on the prosthetic head, this polyethylene is articulated directly in the . This first series gives catastrophic results and is quickly abandoned with the profit of a new model, which associates a mobility between the head and polyethylene and polyethylene and a metal , which is mobile in the . This series will know the disaster of the and will be abandoned for a first system doubles mobility with fixing sealed in the . This implant is abandoned in 1979 for the Tripode without cement, which Gilles will use during all his career.

It used in glance a head of 22,m to preserve the concept of the friction proposed by . Metal was covered with an alumina spray, thanks to a collaboration with Jean , at the École des Mines of Etienne Saint.

This implant drawn in new very few amendments; there was an amendment in the drawing with disappearance of the side ears which could cause conflict with the ; polyethylene was redrawn with the realization of chamfers, to improve the amplitudes of the first mobility, i.e. mobility between the head and polyethylene. It is at the same time as Gilles recommends the use of heads in diameter m and diameter m, since there is sufficient polyethylene. All this is justified following the first episodes of luxation prosthetic.

. : Why was it necessary such an amount of time so that the concept is essential?

F.: The causes are multiple. That is due first of all to the character, who did not have only friends in the csotcina.comedic medium. That as holds with the fact, as double mobility is with against current of the systems unanimously recognized in the whole world. Lastly, it should well be recognized that the School Inhabitant of Saint-Etienne, Gilles , but also his pupils, made nothing to publish on this subject. For a long time, the only publications known on this subject are those of in Caen.

. : It had also developed a knee prosthesis?

F.: I think that Gilles brought much to the hip surgery, but in the spirit of the majority of our colleagues, Gilles , it is before a whole surgeon of the knee. It is true. It made its thesis on the central pivot, under the management of Albert and it thus took part, with its dimensioned, the stripping of the instability of the knee. Its name will remain unrelentingly associated with postéro-external instability; its name will remain associated with the repair with the points with postéro-external angle POPE and postéro-intern GRANDPA… and then his name remains attached to popliteal… In the field of the arthroplasty of the knee, it had developed indeed, the rotatory prosthesis, which associated an automatic rotation of the knee in the movements of bending extension. This prosthesis was developed in the years 1970.

. : It passed to be an excellent operator, though a little aggressive…

F.: All people who it recognize its surgical qualities. With regard to the knee, it made the turn of this hinge. Concurrently to that, it had exceptional performances, which justified its international customers for the surgery . It operated very many professional footballers, in particular of the Italian championship, as still testifies to them the flags fixed on the wall to my office. This fame in the medium attests many surgical qualities of Gilles . It held the Italian championship during years. I think that football, it is really the sport where one can as well as possible quantify the results of the surgery . Many patients of Gilles continued an international career after being operated in Saint Etienne by this uncontested Master.

. : What did it arrive at Gilles ?

F.: It is accidentally deceased. It left to rest in and it was embedded. It was only 59 years old. It should be said that it had a terrible rhythm of life. He worked without stopping. He smoked cigarette on cigarette. He undoubtedly made an heart attack. There are rumors which circulate around its tragic death… This does not rest on any base. I personally learned his death by his assistants who contacted me by telephone. I remember the emotion raised in the Lyons csotcina.comedic world with the ad of this sad news.

. : When did you arrive at Saint Etienne?

F.: September 1st, 1998. Previously, I was in Edouard , in Lyon, with the pavillon T, near the Instructor Fischer where I thought of making all my career. I was at the time Lecturer in Anatomy. I made 9 hours of exchange rate per week. The university of Lyon wished to appoint me, but there was no short-term post, one wished to make me wait.

The release of the post of Gilles created me an opportunity which I seized. At the time, the Lyoneses were disappointed of my departure, many which is those tried to retain me. But it is so difficult to obtain a post of , that when one proposes one of them to you, one should not have any hesitation. I thus accepted immediately the post with Saint Etienne. I was appointed the same year, Instructor and Department head with Etienne Saint.

. : How did your arrival occur to Saint Etienne?

F.: Gilles is deceased on April 14th, 1996. I arrived two years later at Saint Etienne. The service had suffered much. It counted nothing any more but 35 beds instead of 70. The service had been stripped. When I arrived at Saint Etienne, I did not know anybody. I did not even know the structure. I carried out on September 1st, 1998, by sitting me in the armchair of Gilles , that the things were going to be intricate.

The problem was especially to reorganize the service. My first year was devoted to this reorganization. I was particularly well accommodated by the whole of the personnel of the Center of csotcina.comedy. I was also helped, by the support of the secretary of Gilles , who was really the core of the service; I was likely to keep it at my sides. It knew all. It was enough to ask. It especially never gave opinion on its young Departmental manager 38 year old and it was sufficiently intelligent not to make any comparison. The sentence which I feared so much: “Mr did not make like that”, one me it forever known as. It is however about a quite usual sentence which one understands during the changes of six-month period of the interns…

I was also assisted by my collaborators surgeons, Hospital practitioners, Assistants and Interns who allowed me to give again dynamism with the service. In one year and half, we could find our 71 beds to undertake our activity of traumatology and csotcina.comedy.

. : Which organization did you give to your service?

F.: The organization is conventional. There is a staff of traumatology every morning, to take stock with the surgeon of guard and the intern of guard on the inpatients. Radiographic controls of the night are examined. The patients urgently deferred are programmed for the very same day or the days to come, according to pathology and of its urgency, but also according to the availabilities of the block. This is discussed with the framework male nurse of the block. All the surgeons of the service are present.

As wants it the Lyons tradition, Monday after midday is devoted to the weekly conference. It is the occasion to re-examine and analyze all the patient records which will be operated in the week. We have a careful eye on the unit of controls of the previous week. This is the object of criticism possible on the assemblies. We discuss again the difficult files of traumatology which require a spread out assumption of responsibility. Lastly, at the time of this meeting where all the surgeons all of the service are present, the interns, the Framework of Block and the Anesthetist referent, is defined the command of passage of the patients over the week. I must recognize that the role of the framework is essential in the good realization of the program. We have the chance with Saint Etienne to have a Framework, resulting from the School of , which has a broad knowledge of the csotcina.comedic pathology and which has a direction of the organization out of the commun run. Without it, it would be difficult for us to have an efficient management.

Personally, I operate Tuesday morning and Thursday morning, sometimes Friday when there are patients on standby or when there are files to program rather quickly, difficult to put on a regulated program. In addition, since about fifteen years, I have the practice, Wednesday morning, to go to operate in a peripheral hospital, in Saint . Each Wednesday morning, I operate a prosthesis, then I consult.

The architecture of pavillon 1-3, where we exert, at the hospital, is not very favorable, since the ship was rehabilitated and there are difficulties of architectural communications between the two wings of the ship. This difficulty of communication was suppressed thanks to a data-processing network. On line, all the service can know the dates of hospitalization, the interventions programmed and the hardware requirement for the block.

The service has a class project work towards the traumatology which accounts for 40% of the activity. The service is the only department of traumatology of the mining area . We remain the service of reference.  60% of our activity are turned towards csotcina.comedy. In csotcina.comedy, we have a large hip activity, but also a knee activity and an activity shoulder. I have the chance to my to have dimensioned two pH. Frederic is the surgical memory of the service, since it is the pupil of Gilles . He has a general activity, but he is the referent knee in the service. I also with my dimensioned, Laurent Beguin who developed the activity shoulders, although it manages other activities in the service. It is an essential engine which contributes to the rise of the service. With our dimensioned, there are three Assistants, 4 interns. Since my arrival with Saint Etienne, I was always chosen by the Interns, us never had any defection. I have much chance. I am aware of it since many services have problems in front of the shortage of the surgical interns. They know that I thank them for confidence that they grant to me. I believe that all my collaborators contribute to their manner with their vocational training. Finally the team is strengthened thanks to frees-lance: Michel Colas, first Assistant of Gilles , surgeon with Saint , Philippe Girardin, raises cherished of Gilles , surgeon with . The team is also strengthened by , old Internal of Gilles , surgeon with . Doctor Henri , manages the sporting consultation of the service.

. : Which are your problems as a Department head?

F.: The true problem it is the urgency; the true problem it is the respect of the legislation. The service is the only one to ensure the traumatic surgical urgency , 24:00/24 on the sector. The surgeon is of guard; he sleeps on the spot. We have 71 beds. Alas, there are only 5 surgeons seniors who take turns to take the guard and to ensure continuity of care. This poses problem for the management of the surgical activity each day, since a surgeon is in rest of security. The summer obviously, it is not possible to comply with all these rules and we find ourselves in the illegality. Our Head office is aware of this problem well; it makes very to help us.

. : Which was your course?

F.: I always wanted to make csotcina.comedy and surgery; I do however not come from an medical environment. I was born in Lyon, I grew in Roanne where I passed my vat. Very interested by all that touched the world of alive, I told myself that I was going to make medicine. I was very good in maths then one told me not. One should not go in medicine, he is necessary to go in maths sup. Here me is thus party in maths sup with the College of the Park in Lyon. I spent one year extraordinary there because I liked much mathematics; I liked less physics. At that time, my , with the boarding school, had one of his/her friends in medicine in Lyon; I had by this intermediate an articular duplicated lecture note of biomechanics written under the management of Louis Fischer. I was fascinated; I told myself that it was that I wanted to make. The following year, in 1978, in spite of my good performances in maths sup, I entered in medicine to the Faculty of Lyon Grange White. I made a success of my first year. As of the second year, I was registered in human biology, articular biomechanics and third year in certificate of Anatomy. Then, it was the preparation of the Boarding school… I had a very general csotcina.comedic training. However, I decided that I will make hip surgery as of my first half of the year. I was Intern at Claude Régis Michel, who although Patron of infantile, had an enormous adult activity and of total prosthesis of hip. I was subjugated by this surgery and today still, I make gestures that he learned to me.

. : On are the university level, you anatomist?

F.: Indeed, on the university level, I am Instructor d' Anatomie. I continue to teach the Anatomy with Etienne Saint. There is no Instructor of csotcina.comédie and I assume also this teaching. I was appointed in Anatomy, in the capacity as . It is the anatomy which gave me my academic qualifications. I never wished given up the discipline, in spite of the charge of teaching. In addition, for my arrival with Saint Etienne, I had negotiated to remain in Anatomy, whereas the post of Gilles was in csotcina.comedy. It was one
deliberated calculation, because as an Anatomist, I knew that one day I could make appoint a pupil in csotcina.comedy. It acts indeed, of a discipline which generates a colossal activity on the hospital level and which ensures the training of young surgeons, who on the following day, will deal with the population.

. : What do you think of the teaching of the Anatomy?

F.: It is a discipline which I like much. Alas! one teaches today only one varnished anatomical crop at the Medical college. It is admittedly necessary to adapt, because the Medical college prepares with all finally, except with medicine.

On some 700 students, a hundred only will re-enter in medicine, much will not have any exit door, some will be able to reach the dental School, the school of Wise woman or the school of kinesitherapy. All the paradox of the Medical college, in first year, is that it is necessary to teach with all this mass of students, and finally one does not go at the content of the things for the future doctors, who should remain the preferential target of our teaching. Only rudiments today are taught; the drama is that this anatomy is taught never again. This is especially dramatic for the surgical formation. The main reproach with the current organization, it is that there is not D injection of the anatomy on the level of the 3rd cycle for the interns. In our speciality, the anatomy is impossible to circumvent, it remains “the compass which directs” the pitches and the hands of the surgeon. In our speciality, in addition to the osseous gesture, it there with the training of the channels initially; it is at the laboratory of Anatomy that they should be learned.

. : Finally you found yourselves at Mr Fischer?

F.: I was internal at Mr Fisher in 1986, in second year of boarding school. I had appreciated his service for his guideline towards the hip. I had asked him for a post of head. In 1991, I was Intern #D1FFFF medal in his service and I became Senior registrar in 1992. These years at its sides, in its service, with the pavillon T, were marvellous. In this service, I really could learn the hip surgery, because the service preserved a tradition in this guideline, since it was the old service of Mr De . Mr Fischer always honoured me with his total confidence; with him, I took part in the service organization. These years were also marvellous because it is for this period that I strengthened my links with Jean Christophe , now installed with the Private clinic of the Beaujolais wine. We always had a mutual trust. We remain accessory as well in our occupation, surgical around the hip, as at the time of more private meetings. It is as in this service, with Louis Fischer, as we organized on several occasions the Lyons days of hip; these days were decisive in the course of my career. Thanks to these meetings, thanks to the support of Mr Fischer, I could meet surgeons of the hip who always granted warm welcome to me. It is as thanks to the support of Mr Fischer as I could reach the functions of University lecturer in 1994. I owe him much; it does not know can be it not sufficiently; it is the occasion to renew my thanks and my consideration to him.

Lastly, this pavillon T, they is also more personal memories, since it is there that I met my wife, with which I share moments of great happiness. The role of a wife is essential in our trade to assist us in sometimes difficult moments of the university career and surgical activity.

. : Is Mr Fischer always in exercise?

F.: Not, it is with the retreat. It therefore did not give up medicine. It is interested always as much in the history of medicine. It is a man, as you know it, excessively cultivated; he knows painting, the literature, architecture.

I like much painting. We often had with the pavillon T of the discussions around this Article I believe that he knows painting as much as any conservative of a large museum. I remain really very admiring.

. : How are the university hospitals in Lyon organized?

F.: In Lyon, there are three teaching hospital poles. It there at the hospital Edouard . It there at the hospital of the Russet-red Cross with the Center which is the csotcina.comedic department and Southern the Lyon Hospital. Jacques and Jean Paul are with the pavillon T at the hospital Edouard . Guillaume with the pavillon M, of the hospital Edouard , ensures the upper limb activity; he has also the heavy responsibility of manage traumatology; he is helped in this function by his assistant Doctor Jean Christophe Bel. At the hospital of the Russet-red Cross, Philippe is in the Center. At Southern the Lyon hospital, Jean Luc and Bernard Moyen manage the csotcina.comedic activity, but also the traumatic activity urgently of the site.

. : It is said that you leave Saint Etienne for Lyon?

F.: Jean Luc , will take advantage of his rights to the retreat in September 2006. He asked me to succeed to him in agreement with Bernard Moyen, to manage the hip significant activity of this service. I will have great pleasure to work at the sides of Bernard Moyen, whose activity is turned on the knee joint.

I will leave Saint Etienne with regret. Saint Etienne very gave me. I obtained my bond of Instructor; I obtained a of service; I especially obtained the total confidence of the personnel of the service but also of my colleagues inhabitant of Saint-Etienne and of the patients. I will leave really Saint Etienne with regrets because I developed a constructive activity to with it.

However I had been disappointed not to be appointed in Lyon; I had had the impression to be given up a posteriori by the structure which had formed me, and for which I had spent so much of energy. Lyon today wishes my return. It is for me a true second appointment…

. : Which are your fields of predilection?

F.: The hip and still the hip…. I am also interested in the traumatic surgery, more particularly with the traumatic surgery of the mining area. I gave up, since I am in Saint Etienne, the traumatology of the rachis which I practiced in Lyon. I am always interested in the tumoral surgery and I assume the assumption of responsibility of the infectious pathology of the musculoskeletal system.

. : What do you think of the double mobility?

F.: I discovered this principle in Lyon, in the service of the Instructor Fischer, who readily used it in the surgery of the recovery. I had been able to appreciate since 1986, at the time of my passage as Intern, in the service, the interest of this hardware to prevent instability. It is true that it is the essential quality of the double mobility. When I was Senior registrar, I was interested already in the prosthetic surgery of the hip and I used readily this system among patients who forwarded a risk of instability, but also to discuss chronic instability. I remember that I used it readily, in the fracture of the neck when the patient could profit from a total joint replacement of hip, but also in the surgery of the tumoral resection.

. : Don't you find that the indications became excessive?

F.: I do not know. Many surgeons say it. Some even claim that a cup on two sold in France is a double mobility. What is it? I do not know anything of it. It is true that this system experienced a very broad development since ten years. There is undoubtedly a strong demand, since all the manufacturers propose such a system. It should however be recognized that among the problems raised by the prosthetic surgery of the hip, there remains the dramatic problem of luxation. Admittedly, the causes of luxation are , but luxation is always lived by the surgeon like a fault; for the patient it is a failure of the method, even if it often does not reproach anything his surgeon; In addition, much of patients tell with philosophy: “I did something that one did not have. ” Always it is that the operator feels responsible. The things remain all the more dramatic as a luxation on two will repeat. Double mobility, he should well be recognized, puts safe from this accident, this clap of thunder in the serene sky of the result awaited in the continuations of a joint replacement.

. : Do you use on a purely systematic basis double mobility?

F.: Not, certainly not. I privilege among young and active people, the couple alumina-alumina to prevent long-term wear. However, in the event of main risk of instability, whatever the age, I do not hesitate to use this concept which makes it possible to ensure the absence of luxation. In addition, among older people, as of 70 years, I use also double mobility. The reliability curves make it possible today to affirm the absence of recovery at this type of patients; double mobility puts safe from the luxation, which remains the complication first in this elderly population.

. : Where are your studies on double mobility?

F.: While arriving at Saint Etienne, I knew that I will give up the screwed stem. Indeed, I defend with conviction, the use either of this screwed system but of a quadrangular stem without cement covered entirely with hydroxyapatite. With group , we have such a constancy of results that there was no more place for the system screwed with its procession of problems. I as knew while arriving at Saint Etienne, in the capacity as surgeon of the hip, as there was a priceless scientific inheritance around this double mobility. It was still about a system little known. The School Inhabitant of Saint-Etienne had published little. There was very to make. I was particularly helped by my collaborators. Remi devoted his thesis of medicine to the review of a troop of patients to 10 years. He provided us a reliability curve. The results at 10 years are good and are completely comparable with more conventional methods.

Frederic worked on becoming to it patients of less than 50 years; the results were published in the French company of Hip surgery, at the time of the symposium directed by Henri and Christian . The results of our series were criticized, however within sight of our confidence interval, double mobility does not have demerit compared to the different systems. Our reliability curve was penalized by the debatable change of the cup for two luxations prosthetic, whereas one could have been satisfied with the change isolated from polyethylene. Philippe Adam devotes his thesis of science to the double mobility. He worked on the analysis of the wear of polyethylene. Laurent Fancy, Olivier and Sophie contributed to their manner with the analysis of the results.

Lastly, we currently work on two axes. The first axis is devoted to the analysis of the stresses to the interface of the cup and the bone.  The question is to know if double mobility makes it possible to decrease these stresses with the interface. The second axis is the analysis of luxation prosthetic. We have a troop of an about sixty patients who forwarded such a complication. We seek the supporting mailmen which could lead to such a luxation prosthetic. We retained the young age of implantation. It would seem that this luxation prosthetic is not only the consequence of with the coll It seems indeed, that the report head neck does not explain to him not only occurred of such a complication. There are indeed two mechanisms which contribute to this luxation prosthetic. It is the drawing of the neck which starts this complication. It is undoubtedly necessary to optimize the drawing of the neck to be established opposite a double mobility.

. : Have a fundamental research activity?

F.: I am member of a team INSERM. I take part in the activity of the laboratory of biology of bone tissue directed by Laurence , in Saint Etienne. The team is interested in the amendment of the bone to the stress. We have a work of analysis of the stress around a femoral stem without cement. The transmission of the stresses on a normal femur is well-known since work of in 1917 and , in 1968. At the time of the implantation of a femoral stem, because of section of the neck, the head does not forward any more its stresses in voltage on the cortical side one and its compressive stresses on cortical the . After implantation of the femoral stem, the stresses are forwarded by the head to the femur by the femoral stem. We lead an analysis by extensometry to the École des Mines, as well as a radiological prospective analysis, and especially a exploratory study. We hope to be able to define a predictive model by finite element, in order to quantify the role of the prosthetic mailmen: alloy, size, quadrangular or round form…, of the surgical parameters as “did it” femoral, refund of the lateralization and the physiological parameters of the patient like the osteoporosis.

We are also interested in surgical navigation of the hip, and we could undertake a work with the École des Mines for the analysis of the cone of functional mobility of the normal hip at the time of various spots; these physiological data of the normal subject are confronted with the possibilities offered by the joint replacement, according to the relative position of the parts. In the same work axis, we analyze the reference frames mining area and femur.

. : Which are your objectives for this year?

F.: I first of all wish to maintain the activity with Saint Etienne until my departure. Obviously, I organize my return on Lyon, since the post was opened with the Official journal.

In the short run, I prepare with group the 20 years organization CORAL.

I also go, you imagine it, to continue on the channel of the fabulous history of the double mobility.