Christian Delloye is department head with the University Private clinics Holy Luc in Brussels. He worked much on the osseous and was at the origin of the development of one of the main tissue banks of Europe. It is also interested in many fields of the csotcina.comedy on which it has a very holistic glance. This Meeting with Christian Delloye, at the time of the meeting of which it organized the last fall in Brussels, is an excellent occasion to upgrade to us in the vast field of the osseous tissue replacement.

 

. : Which were the contributions of the congress?

: The first topic of these two days related to osseous quality and one saw several ways there of measuring the bone. Everyone knows the quantitative approach of osseous mineral by the but only, it is not enough to explain and predict all the fractures related to the osteoporosis. Other mailmen influence also osseous solidity. It is necessary to utilize the concept much more recent of osseous quality. And in osseous quality intervene of the parameters like the qualitative mineralization of the bone, the bone metabolism and . For example, equal mineral density better, the cancellous bone will resist where its osseous spans form a network well connected between them and much less better where the spans are insulated. In the dense bone of cortical, the concentric plates of the can be opposed to mechanical fatigue while becoming deformed and by limiting the microscopic cracks. One reports oneself that with the age, the microscopic cracks accumulate and that the risk increases by as much. In short, this day showed us approach very varied bone. The osseous remains the basic way but it will grow rich by other parameters of evaluation.

. : With would equal age and without pathological context, two individuals of the same sex have bones of very different quality?

C.D.: Completely! Our skeletons are not equal! And in this field as in good of others, one finds the genetic factors. Let us take for example, three astronauts in whom one measures the bone mass before their space flight. During the aforementioned, the three lose bone but at speeds and different quantities. Returned on ground, the renewal of bone mass will be done here also according to curves different of increase. With similar environment and fuel supply, the differences are explained only partly by the bone density. Other mailmen such osseous quality and the cellular metabolism enter also concerned. Indeed, the mechanoreceptors can be more or less numerous and regulated on thresholds of different sensitivity involving a variable cellular response. The bone is a composite tissue organized on several ladders. On each level, many differences can appear. It there with the macroscopic geometry of the bone, its , the mineral composition and collagen, its bone density and all these parameters explain the individual differences. Even on a microscopic scale of a bone, the deformability of within the same compact bone is very variable according to the size and the localization of the latter, as have just shown it the engineers of the Central School.

. : Which is the origin of the microscopic cracks?

: For the fundamentalist ones, a microscopic crack is the result of a local damage of the compact bone which appears when its cyclic weight-bearing is repeated too much. A microscopic crack represents a mechanical fatigue of the bone. Some locate them in the interstitial lamellate bone while others preferentially locate them in the .  The lamellate structure of the bone makes it possible effectively to be opposed to the propagation microscopic cracks. The microscopic crack causes the setting concerned of the repairing mechanisms with the successive appearance of the osteoclastic trepans and the affixing of a new bone. The tired bone is replaced by a new bone. One estimates at 5% of the bone mass, the quantity of bone which is thus annually replaced.

. : Does that have therapeutic consequences?

: Not, for the moment, surely not. Our current therapeutic approach remains centered primarily to the measure of bone density. There is nothing currently very again in our therapeutic approach which remains mainly based on the medicines.  Beside the inhibiters of the bone resorption the such bisphosphonates, appear other molecules able to stimulate directly or indirectly the formation of new bone like the strontium or the which is the initial sequence of the recombining parathormone.

. : To return from there in what interests the surgeon, is there the new one in the biomaterials and the bone substitutes?

: Nothing new good currently. The bone substitute more used remains… the bone! Apart from the bone, in fact ceramics is used. Their defect: they are friable and breakable with a rather weak mechanical performance. Very resistant in compression, they are it much less in torsion or bending. They are difficult to work as an operating-room whereas the bone grafting tolerates the made-to-order setting best. The strong point of ceramics is its excellent biocompatibility with the bone. It is necessary thus well to know the limits of ceramics if one wants to use them without concern in room. One needs an intimate contact between the bone and the substitute to lead to a rigid interface.

ceramics is used as material of filling and must be protected mechanically. In an tibial osteotomy of opening, the internal plate protects the substitute.

Some will tell you that one requires nothing to put whole and that goes just as easily. This joke is certainly true when the loss of bone substance is very limited in a little mechanically requested area. But which would take the risk to leave vacuum an tibial osteotomy of addition?

. : Where do you put your bone substitute?

: Where there are a vacuum or an osseous embrittlement. It is sometimes a comminuted fracture of the distal radius, a fracture packing of a tibial plateau or an humerus , sometimes an osseous disease a such tumor. The substitutes whatever they are, avoid a capture of Clerc's Office with all the sometimes important nuisances related to this taking away. It is comfort at the same time for the patient and the surgeon. With the invasive mini tendency, it is clear that one resorts more easily to the substitutes than with the autograft which requires an additional operational time

. : Do the osseous pastes have mechanical qualities near to cement?

: About which cement do speak you? Cement of that we all use, has a mechanical behavior higher than biological cement and the osseous pastes. Hydraulic cements containing phosphate and of calcium have a slower capture to form a not very resistant ceramics mechanically.

The osseous pastes are not comparable with cements because they really do not harden except for rare exceptions. The osseous pastes are variable formulations to obtain an injectable or malleable bone grafting. They do not have any role nor mechanical ambition. The pastes were worked out for an easier installation of the Clerc's Office which, by its maneuverability, marries contours of the site in which it is put.

. : Which is the advantage of the freeze-dried compared to the hydroxyapatite or with synthetic calcium phosphate?

: The freeze-dried Clerc's Office has in more osseous collagen. It remains a composite material with a mineral phase which coats the organic phase whereas ceramics has only the mineral phase of the bone. That gives him a better mechanical resistance in compression. Once reimplanted, the bone freeze-dried slowly in a few mechanical days and its securities approaches those of the normal bone thus. There is however much similarity between the bone freeze-dried and the hydroxyapatite before the implantation. Not established, they are all the two breakable ones. Established, they are very slowly reabsorbed both. This resorption essential for is not freeze-dried which with the same bone density.

. : Did one show differences between the freeze-dried and the of bank?

: Let us not confuse! There is no difference between the freeze-dried and a of bank. The indicates any tissue coming from a different individual but of the same species than the patient receiver. Practically, all is always a of bank i.e. it was preserved in a way or another. Indeed, it is difficult to use a fresh and not preserved in routine because it is imperatively necessary to check the absence of transmission risk of diseases within very short times.

Freeze-drying is a method of conservation which dehydrates without denaturing the matter by the share of the vacuum and the cold. The great advantage of freeze-drying is to be able to preserve at room temperature the freeze-dried matter. On the logistic level, it is an enormous advantage because the routing of a freeze-dried Clerc's Office is much less constraining than a frozen Clerc's Office. The astronauts or the mountaineers know freeze-dried food and everyone knows . of Stockholm showed that a bone grafting without marrow much better by the airframes of the host than a Clerc's Office which preserved its marrow. Freeze-drying or congelation does not amend this observation.

The ablation of the marrow of the bone became quasi the rule for the bone which we discuss and represents one of the stages of the processing implemented to the bone.

In Brussels, we have the chance to have a large tissue bank which turns very well. Managed by csotcina.comedists, it adapts to the preferences of the surgeons who can choose freeze-dried or frozen.

The Clerc's Office is cleaned, removed from its marrow and forwarded to processing. It can be precut with the request, frozen with -80° C or freeze-dried. With final, the bone which we send does not contain any more marrow. It is really only of the osseous frame.

Between the two forms of conservation, I have a preference for the frozen bone.

. : Why?

: Because mechanically the frozen bone graft more solid than is freeze-dried. The frozen bone can be worked again by the surgeon without any problem. It supports an osteosynthesis easily. Freeze-dried is on the other hand, more breakable and is more delicate to work. It is appropriate for wonder in the small indications. It is enough to leave it packing and to use it. On the logistic level, freeze-dried is surely higher. Indeed, freeze-drying makes it possible to preserve at room temperature and thus to have a reserve to face the urgencies. Freeze-drying releases the surgeon of the stresses of the cold. For frozen, it is necessary to make come a container from refrigeration, to heat it: it is thus a heavier method.

. : But then, is it necessary to continue to keep the femoral heads with the refrigerator?

: The things are more intricate than that. Let us say first of all that the refrigerator is not a solution because it has only one temperature of 4°C. This refrigeration is insufficient for a long conservation. Only, congelation with must be retained and discussed.  It was and remains in 2006 the referral procedure for the conservation. If its implementation remains heavy and constraining because it is necessary to adhere to the low temperature to the user, congelation is a method which is with the range of any bank because it easily available. The congelation of the femoral heads remains the preferred method if these heads are checked serological second of the donor with 4 or nths following the countries. It is for me, the procedure of choice in so far as an exit of forty is possible. If control after taking away cannot be assured, it is then necessary to resort to other means as the what forces to discuss the head fruitlessly or to sterilize it after processing and to decide if one chooses congelation or freeze-drying for the later conservation.

In the world, the large banks prefer a chemical dehydration or a freeze-drying of the bone because the logistic stresses are less large. When we freeze-dry, we prefer to irradiate then to guarantee the sterilization of tissues but this irradiation will decrease by approximately 30% the mechanical properties of the bone. The freeze-dried bone and man exposed to atomic radiation are more breakable and less resistant. It is thus necessary to know the limits of material for good to use it.

The freeze-dried bone higher than is frozen in the techniques of osseous impaction of the parcelled out Clerc's Office because being more breakable, it is impacted than frozen better and more quickly in the femur.  The frozen bone, man exposed to atomic radiation or not, have quasi the same mechanical properties as the native bone. One will quasi exclusively use it like grafts structural.

. : Can one enrich the osseous biomaterials?

: Yes, certainly with the systems of platelet freezing which carry out a concentrate of platelets , rich in growth factors and thus favorable to the of the bone. It is better than blood. Another way of enriching a biomaterial, osseous or not, it is to put bone marrow coming from the iliac crest of the patient. This marrow is easily taken by puncture and it is already very well because it contains airframes and is richer in growth factors than blood.

. : Is the quality of the autograft very different according to the sites?

: Certainly. Let us distinguish osteogenic value and mechanical value. Where there is #53B0A6 marrow, there is potential osteogenesis. The radiologists show us that in the adult, #53B0A6 marrow remains in the flat bones such as the or the breastbone and in the vertebral body. Therefore, a spongy autograft with a high capacity of osteogenesis will be taken in the mining area. The pelvic autograft is that which has the most capacity of “capture”.  In a radius or an adult tibial plateau for example, there is especially fat marrow and this Clerc's Office has only one low capacity of osseous formation.

There is also the mechanical value of the graft. It depends on the bone mineral density. The age is a dominating mailman here. Having realized in the past of many osseous taking away, I can tell you that at the same subject, the cancellous bone of the femoral condyles is definitely more resistant than that of the tibial plateaus. You cannot depress the cancellous bone of a tibial plateau that if it is approximately 40 years old, while you will pass the inch through if it has more than 55 years. In a condyle of femur, the cancellous bone remains very solid at a subject without notable antecedents, up to 65 years. When the “bankers” want to prepare a dense cancellous bone, they will take it on the level of a femoral condyle.

. : Which precautions is necessary he to take with an autograft?

: The autograft with several properties. The first and it is most important, it is immediate osteogenesis. If the Clerc's Office is transplanted in the three hours, you have approximately 50 to 70% of the osteoblasts which survive. It is thus not totality! So moreover, you exceed this time, survival will decrease in a way even more important. But even during these 3 hours, it is advisable to protect the autograft that you have just taken. The majority of the surgeons leave the Clerc's Office in a container on the table and with the free air without being concerned with it too much. By doing this, the exhibition to the air destroys the airframes by the dehydration which it involves. It is very important for the success of this autograft to put it in a compress soaked with saline to avoid the cellular

. :  Does the light play a part?

: Not that I know! On the other hand, the role of the dryness was well shown. Good protection, it is the wet compress! The second property of an autograft, it is the and it is a property which one can measure thanks to work of the Swede. It developed a small measuring chamber in which one places the sample to be evaluated in contact with the osseous bed that by only one face. After a few weeks, the sample by the airframes coming from the bone receiver and one measures on histological cut the distance covered by these airframes in the specimen since the osseous bed.  One can thus study the influence of a processing or compare the performances of the bone substitutes while placing them each one in a room in the same animal. It is with this method which it showed that the ablation of the marrow of the bone increased the cell migration.

The third property of the autograft, it is the . One can say that any bone contains Maid , that the aforementioned belonged to the organic matrix and that it is protected by mineral. It is necessary a preliminary demineralization so that it can be expressed. But I do not see how one can affirm and show that the autograft is whereas it contains already at the beginning of the airframes . With my opinion, that shown forever formally in the literature. The model unanimously recognized to check the , it is the implantation of the agent in a site which does not have any osteogenic airframe like the muscle or subcutaneous tissue. If it occurs bone, it is that there was recruitment of surrounding airframes to make them differentiate in osteogenic airframes.

. : Who developed this concept?

: It is which created the term and developed the concept. How did he discover the ? He studied in the Sixties, the mechanism of the mineralization of the bone and he had asked for one its pupils of decalcify segments of bone of rat, and then to reimplant them into subcutaneous to see how they were recalcified. He thought of obtaining a recalcified bone but he had the surprise to note that the bone was not recalcified but that he was the seat of a lysis and an affixing of new bone. Airframes of the host had infiltrated the decalcified bone and had been transformed into cartilaginous airframes. This cartilage was then replaced by a new bone. It did not expect that at all. Thus he discovered the starting from a decalcified bone. Several decalcifying solutions were tested and it is the hydrochloric acid which appeared most effective. The concept of is launched since 1966. But had a precursor quite as brilliant. Since 1949, the phenomenon of the had been described by the Instructor in his book “the organization of the bones”. was the first instructor to occupy the pulpit of csotcina.comedic surgery at the catholic university of Leuwen. It takes a bone of the rabbit tibia, puts it in pure alcohol during 13 days and reimplants it under the renal capsule or the skin of the ear of the same animal. He repeats the experiment but with a pulp during inutes. After nths, it with the surprise to note that where it had there a Clerc's Office preserved in alcohol, there is an ossicle worked out by osteoblasts with in the center, an hematopoietic marrow. On the other hand, it finds the Clerc's Office quasi intact pulp. The 2 sites give the same results. He wonders: “Which is the substance released by this which causes the metaplasia of surrounding connective tissues?”. For him, the osteogenesis observed in the Clerc's Offices of killed bone is due not to the release of calcium salts but of an osteogenetic organizing substance which it names “”. Prophetic, he wrote at the end of his book in connection with the future prospects which it is not absurd to imagine that one can one day obtain the cure of a pseudarthrosis or ensure an arthrodesis using the .  It was in 1949. It was necessary 40 years so that is concretized since it is in 1989 that the BMP was purified. But one cannot say into 2006 that the BMP really were essential.

. : What wedges?

: The bone is a tissue which contains a great number of growth factors. These mailmen are not there by chance. They have a whole a role to play. In the bone, the concentration of the BMP is about the nanogram per ml. She is proposed in private clinic in amount of milligram per ml is an increase in the physiological concentration of a mailman 6. The cure of a fracture brings into play a cascade of combinations of various mailmen. I would say that the osseous consolidation is a symphony played by an philharmonic orchestra in which the BMP is a soloist. Can a soloist play the symphony? Unfortunately not! He can have a big role especially to start at the beginning the cascade of the events, but that does not seem sufficient.

. : Especially if one does not know at which time the BMP does intervene?

: It is one of the main issues of any mailman of differentiation: at which moment and with which must it be salted out to obtain an optimal share? There are mailmen activators and other . Among those, there are which will degrade it. Some consider supports which would put the BMP safe from such proteases.  We are unaware of at which time its presence would be optimal and we do not know the ideal support for the BMP. Is bovine collagen the best vehicle?

All that yet well-known and is not codified. One is thus in a phase of groping although the BMP form already part of our therapeutic arsenal. The major brake with its clinical use in fact the price borders the 4000 E the amount. In fact, there are only two exploratory studies randomized on their use in csotcina.comedy. It is thin. Everyone has this idea with the spirit but it is not yet in the daily practices. However the iterative interventions for pseudarthroses cost very expensive and if one manages to show that the cure of the nonunion can be obtained with the BMP, the public authorities will probably facilitate the settlement of these molecules.

. : What think of the of soft parties?

: Good. For a few years with Dr. Horned Olivier, csotcina.comedic surgeon who is in charge of the tissue bank, we have observed a very significant rise of the demands for ligaments, tendons and fascia-lata. It was precisely one of the topics of this annual meeting of the and we intended 7 teams to have the results of the in instabilities of ankle, the hand surgery or instability . The of the knee and the rebuildings of the aircraft bungee cord of the knee were also forwarded and I am astonished to see the quality of the results with more than 5 years by retreat. In 15 years, we prepared many grafts. We had started by taking patellar tendons and Achilles' tendons with their osseous insertion. For 10 years, we have taken also leg former and posterior ones as well as the fascia-lata. Certain surgeons prefer tendon, others of the fascia. It is business of crop and school. The taken tissues undergo a disinfectant processing during approximately an hour with alcohol 70% and with 0,02%, then they are frozen with -80 . It is really pure connective tissue which one reimplants. The request remains very constant. I am very happy quality of the long-term outcomes. It is thus well a reliable material which the surgeon can use without ulterior motive.

. : It is what seems to show the American series…

: Yes, there is convergence and I can confirm this tendency although there is a difference in preparation. The American are irradiated, not ours. There was in the Nineties, an American passion to rebuild the former crusaders with a Clerc's Office sterilized by irradiation or ethylene oxide. Then it appeared in the USA of the phenomena of synovitis with tissues exposed to ethylene oxide. This type of sterilization was quasi abandoned with the profit of the irradiation. In our bank, the are not irradiated because we estimate that the selection and the sifting of each donor by molecular biology enable us not to resort to this secondary sterilization which weakens collagen. The demand for substitutes remains very strong in the world. The Americans reconsidered their indications of by reserving those for the surgery of recovery. Our bank never makes publicity for the because there are alternatives. Currently, we would say that the , it is surely very well in the surgery of recovery but that it is necessary to privilege other alternatives in first intention.

. : Which are the results in the replacement?

: In the ruptures of the cap of the rotators, I had an original technique which used a 4 cm long distal fascia with its osseous fastener. I made a trench in the and inserted the bone in the aforementioned. After joining of the fascia to the section, this assembly was very solid. At two years, I had a half of functional excellent results but other half had not been improved. As I think as if I had not put anything, I would have had also excellent results! With my opinion, there is no indication of substitutes for the old ruptures of the cap because at this palliative stage where the direct joining is not possible any more, the atrophy is already present.

With regard to the former crusader, one showed by histological studies that it and that it is many airframes of the receiver which the implant. J. and NR. recently published their results of 92 former crusader in the French review of csotcina.comedic surgery. They have 88% of goods or excellent results at 5 years. No rupture of the graft nor synovitis were observed. 70% of the patients took again the same sport on the same former level.

The rebuildings of the aircraft bungee cord of the knee relate to the surgery of resumption of prosthesis and often among patients having an rheumatoid arthritis. A series of 22 patients was forwarded with a 5 years passing. No operated uses an orthotic device but on the other hand, they use a whole a cane. It is thus not perfect but it is a Net progress nevertheless! The average deficit of extension is of 13° and these long-term outcomes made it possible to make these patients completely autonomous.

Lastly, the results in nths of a multicenter trial on the use of the in instabilities of ankle were shown very conclusive.

. : Is it necessary to continue to take and store ?

: Completely! I did that during 15 years and now I stopped because it was very constraining. I had the chance to have an intern who was interested very early in the . It is Dr. Olivier Cornu who has taken again the torch for 10 years.  It is necessary to have a solid team to face the taking away. In the United States, they are male nurses who practice the taking away. In Brussels, we think that only a surgeon can take what another surgeon will reimplant and it is especially valid for soft-tissues. Also, we want to maintain surgeons in the team.  The aforementioned associated the services of 3 ancillary medical and turns around Dr. Olivier Cornu who remains always enthusiastic. He is assisted by Dr. Vincent but it is necessary to think in the long term of the renewal.

. : In which structure do work you?

: I work in a university structure of 900 beds. I am chief of the csotcina.comedic department and traumatology of the musculoskeletal system and chief of the department of surgery which gathers the departments of surgery visceral and of transplantation, the plastic neurosurgery, it, urology, gynecology and obstetrics. Our department of csotcina.comaedics contains 77 beds and functions with 10 permanent surgeons, 7 interns resident or senior registrars. We also have 3 intern who ensure by rotation the traumatology of gate. We practice almost all the subspecialties of the discipline.

. : Why do you have a tissue bank on the spot?

: Because my predecessor, the instructor Pierre De made csotcina.comedy. He thought rightly that the could be extremely useful in the rebuilding of the skeleton after this surgery. He had been raises of Blackbird of and . 

He had made two or three rebuildings with a of corpse and had encouraged me to start that. I started in 1981 and I found this surgery enthralling. Supported by my departmental manager at the time, the Instructor André Vincent who was very enthusiastic for the bone graftings, I devoted two years to make search experimental on the bone and the Clerc's Offices and I supported in y thesis of aggregation of university education on the .

I was very marked by work of and which were the time. To study the freeze-dried Clerc's Offices, we had to build with the aid of Faculty, a adapted for the bone. It is because we precisely had this for experimental Clerc's Offices that we used it in private clinic for the human Clerc's Offices. If we had not studied the freeze-dried bone, we would have adopted only very tardily in private clinic this mode of conservation. Search thus helped us well. 

Twenty-five years after, I keep same enthusiasm for the . It is clear, they have their defects and their limits as any material but if you know them, then you will not be disappointed.

. : How do you proceed in practice?

: The taking away is done on donors of parts which are relatively young, the Middle Age being of 40-50 years. The preparation is that of a conventional surgical operation, with hand-washing, blouse, double conventional glove and . The long bone is taken in entirety. In general, the four long bones of the lower limbs and a or an humerus according to the needs, of the mobilizable team and the serviceable time. The members are always rebuilt with articulated and modular metal prostheses. The covered bone of its cartilage and the joint capsule is prepared by leaving main insertions. After taking away for bacterial analysis, the bone is immersed inutes in a solution of with 8% in which one adds since 1995, of the at a rate of 1,2 . It then is packed fruitlessly and put without delay at - 80° C. It is quarantined and will be radiographed in the following days. The bone can be a vehicle for the antibiotics which are adsorbed on the surface. The is very interesting for us because it is especially active against the positive and resists congelation perfectly. This thermal stability explains why the bone after defrosting, salts out antibiotic with effective doses during approximately 6 weeks. It is there an additional advantage of a massive .

. : How long can you thus preserve a ?

: Legally, the duration is limited to 5 years. We have only very few scientific data to support this duration. I think that it is especially the guarantee of a conservation without fault i.e. without any rupture of the low temperature which is most important. The radiography of a bone preserved more than 10 years at - 80° C does not show any deterioration of mineralization but we do not know if its capacity of is faded or not. In a bank which “turns”, it is rare to be able to keep parts as a long time as 5 years.

. : Is the structure of freeze-drying different?

: Freeze-drying is done in the same structure of bank. We have just moved in a news tower which the private clinic has just built. It is a tower of laboratories of biology and whose last stage is partially busy by the bank. We have there a technical plate of 2 which at the same time makes it possible to store the bone of bank, to make safe the bone and to prepare tendons. The processing of the bone is done as a cleanroom i.e. in a room dustfree or particles. The became industrial and is accessible since the cleanroom. In order to make benefit the surgeons from the security of the bone, the bank established Conventions with the peripheral hospitals. The peripheral surgeons or banks send the heads of femur to us to make safe them. The heads are kept on our premises either frozen or freeze-dried according to the wish of the surgeon. They are then sent to them to the request.  Each surgeon has his reserve thus and is certain not to be with short if it has a regular activity. We assume the responsibility for the Clerc's Office. In Europe, we were pioneers in this sector of freeze-drying. Since 1982, we proposed also the massive Clerc's Office with insertions and the cartilage in order to be able to make if necessary, an articular Clerc's Office. In 1989, I had the honor to receive a request for Clerc's Office of Mario of the Institute of Bologna. As the operation had occurred well, he asked me to be able to continue what he did until his death, 10 years later. We then helped in Bologna and in Florence to establish their own bank. It is a great satisfaction for me to know them all the two autonomous ones.

. : Does twenty years after this period of expansion of the , how arise the market of the bone?

: Than provided for very well and better! When the bank entered the structure of the university hospital little by little, the Director of the hospital had told me in 1989: “Mr Delloye, in 20 years, he will have there no more bank of bone because the Clerc's Offices will have been replaced by substitutes.” This forecast will not be carried out also quickly. The best proof is than the bank has just moved in the news tower with the agreement of our authorities. It should be said that if there are to replace the great losses of substance, the osseous makes it possible to reintegrate tendons much better than metal. In the child, the possibility of a Clerc's Office prevents the useless sacrifice of a cartilage of growth which is not reached by the disease. Lastly, certain localizations as the mining area are more favorable to the Clerc's Offices than with the prostheses, even to measure.

For the small bone graftings, one can wonder indeed whether ceramics will not take the pitch. That will depend on the offer of the tissue banks. If the offer in bone grafting is real, I think that the surgeon will always prefer a natural material like the bone with a synthetic material. Therefore, the bone keeps a bright future!

. : How does an osseous age?

: It is a difficult question. Sixty percent of the massive do not have any problem. It is generally the case when the Clerc's Office is associated with a joint prosthesis. Forty percent will pose at least a problem either of nonconsolidation or of fracture. This last complication has a randomness which makes it awkward for the patients. They is not very foreseeable and thus tedious. For me, the fracture of a translates the fatigue of the material which cannot be renewed contrary to what occurs in a normal bone. Consequently, the patient and his family must be informed that the bone which is established is not a normal bone and which it can break. This is why a massive must always be armed by a metal hardware.

In general, I have as a practice to say that a which is broken must be replaced. One tried several times to repair them with autograft but the results were always very disappointing. This is why of Florence associates with the a vascularized fibula. The gives immediate solidity and authorizes a rapid weight-bearing while the ensures perenniality by its vascularization and possible hypertrophy. It is an excellent marriage.

. : How much bank in Belgium?

: In Belgium, there is about fifty banks which preserve and prepare several types of different tissues, i.e. (cornea, ossicles ENT, valves cardiac, arteries and veins, bone, tendons, skin, amnion). Will associate the banks with it with cellular activity such blood of cord, the small islands of pancreas, the hepatocytes, the hematopoietic cells of blood etc.  It is the first country in Europe to have legislated in 1988 on the activity of tissue bank. It is not pain-killer. It is the first country to have published the price of the Clerc's Offices in its official journal. For us it was an officialization which made the things completely transparent. A specific booking for each type of tissue near the ministry is obligatory. For the bone, there is either an approval for the femoral heads or an approval for tissues of the musculoskeletal system with the massive Clerc's Offices and the tendons. Approval is given only after one inspection and will be renewed only after inspection and compliance with the specification.

. : You, you constitute a large bank?

: Yes! It is even one of most important of Europe if one considers the massive Clerc's Offices which are especially used for the tumors or the very difficult overhauls of prostheses.

. : How is csotcina.comedy in Brussels organized?

: In Brussels there are two French-speaking universities: Universit3e libre de Bruxelles and the catholic university of Leuwen , and a Flemish university. There are thus three university hospitals with each time, a department of csotcina.comaedics and a tissue bank. Concurrently to these three university structures, there are the private clinics which are either public or private. The patient can choose the place freely where he wants to be neat what explains why competition is very sharp because the patient with the embarrassment of the choice. Belgium is a country of choice as regards health with a completely excellent level of medicine.

. : Which are your fields of predilection?

: Shoulder surgery and csotcina.comedy. The primary neoplasm of the bone and the sarcomas of soft-tissues are my ground of election. The primary cancer of the bone remains rare and it is necessary to count approximately ten annual cases per million inhabitants is 100 patients for our country. For the sarcomas of soft-tissues, that made approximately 300 to 400 patients a year. And then I also endeavor to maintain an clinical activity sufficient and not to let me submerge by the administration of the department of csotcina.comaedics and the department of Surgery. Because it is the clinical activity and operational which supports the surgeon and keeps it flared.

. : You come from a family of doctor?

: Not whole. I come from a family of industrialists and there was no doctor in the recent generations. I was born in , small town along the Meuse between and Liege. For professional reasons, my father engineer came to settle in Brussels where I made my studies. I had the vocation of surgeon towards age the 15 years and I began the studies of medicine to become surgeon.

. : Why?

: I do not know anything of it, if it is not that it was time of Christian Barnard and first grafts cardiac. At the 15 years age, I collected in a book which I still have, all press articles on the Clerc's Offices of parts that I found attractive. For me, to become surgeon was an enthralling objective which I could carry out and I do not certainly regret it!

. : Why did you choose csotcina.comedy?

: During my training courses in surgery, I was attracted by the csotcina.comedic surgery. To rebuild a skeleton appeared a very beautiful ambition to me. I had been unconsciously prepared in my childhood by two experiments which had to mark out my choice. Towards the 6 years age, I indeed had been very marked by an motorbike accident and the sight that I still keep in memory, of one lying unconscious on asphalt with a deformed thigh had strongly impressed me. I had been it as much towards the 10 years age by a lady which had had a tumor of the jaw and which carried a scarf permanently. I thought that it was to be socially terrible for this lady to be disfigured with life. I thought that if the surgery could repair that and give again a normal face to him, it would be a fantastic challenge.

. : Which were the outstanding moments of your boarding school?

: I initially started in , to m in the south of Brussels at Mr who was a pupil of Blackbird of about which he spoke to us with large respect. It was a rigorous and cultivated man who taught me the ABC of csotcina.comedy. I remained three years there. Then, I was in the service of Mr Vincent who was the owner of the service with the . It is a gracious, generous and very enthusiastic man. 26 years afterwards, it is always the same man with these beautiful qualities. It is him which started again me towards the bone graftings. I wanted indeed to make search during my formation and it is one of the reasons for which I had returned to the university hospital whereas the side large factory did not attract me at all. But there was with faculty a laboratory of csotcina.comedy which had been rested by the Instructor and where the Instructor Coutelier worked. They had studied the consolidation of the fractures and they had developed a beautiful tool which was called the microradiography.

. : I.e.?

: It is a microscopic radiography which makes it possible to see the various degrees of the mineralization of a bone. It is where I discover what is a cortical bone, that there is osseous airframes, that a bone saw and renews themselves. My first interest for search, it was electricity and its potential share on osteogenesis. Also when I return in the Vincent service, it is the had a presentiment of topic of my search. This choice was not possible because one of the members of the service had gone to New York at to study the magnetic fields and to develop them at the laboratory. Mr Vincent launched me at the time: “Instead of the electric currents, you should interest you in the bone graftings”. Electricity in 1980, it was tendency while the Clerc's Offices, it was not with the mode. It is thus with the bone graftings that I began my period of search. I then discovered a laboratory where all was preciously kept by Coutelier who had succeeded . The laboratory was a true cave of Ali-Baba. It was as if I entered an attic. There were splendid documents. I thus discovered a letter of writing with this: “Looks in this envelope, there are some fragments of diaphyseal bone of rat which I decalcified with hydrochloric acid and which were freeze-dried and sterilized. If you establish them in the muscle of a rat, you will obtain new bone”. Nobody had never left the bones their packing since 1971 and I am say that I was going to establish them later 12 years. It is what I did and I obtained a splendid new bone and this, whereas that had been stored during 12 years under completely banal conditions. The implantation in the rat induced the formation of a new bone. If it is easy to obtain a in the rat and rabbit, it is much more difficult in the dog. Some say that it is a question of original cell but I do not think it. This problem constituted part of work of my thesis. My conclusion was that so that the by implantation of demineralized bone functions in the dog, the bone had partially to be decalcified but not completely. Demineralization is the only way of exposing the organic matrix. The BMP which is inside the organic matrix is thus protected from the proteases which, if not degrade it. In the dog, it is necessary in addition that there are a synergy of the BMP with the monocytes and macrophages of the host so that induction engages from where incomplete demineralization.

. : If one keeps mineral the BMP does not express?

: Not. The bone should initially be demineralized at least partially.

. : But does the demineralization of the bone release the BMP afterwards even several years?

: Yes, thanks to freeze-drying or with congelation. Freeze-dried, that wants to say that there is no more water and if there is no more water, he does not have there more chemical reactions. The freeze-drying from the logistic point of view it is brilliant. You can keep it years in a dry place. Later, in 1984, I was in Canada, more precisely at the university at Francis Glorieux. There I made crops of airframes on tops of the skull of rat. One put pieces of glasses and one managed to attract the osteoblasts on the piece of glass. It was a very astute way to insulate the osteoblasts because in general, the researchers use enzymatic methods to manage to take off the airframes of their substrate. I studied the influence of the proteoglycans on the mineralization of the bone. One managed to reproduce in vitro the mineralization of these airframes. I did that during one year and half and that enabled me to understand what it was an airframe and to understand that the control of mineralization was not done in any circumstance. I also discovered the precision of biochemistry. The surgery even specialized, that remains less precise in comparison with a science like biochemistry. This Canadian stay made me understand the importance of the cell interactions with the matrix and the potentialities of the cell culture which must still develop in our discipline.

. : Which were your other work?

: I studied the mechanism of the lengthening of the bone according to in 1985, after my return of Canada. We had the chance into 1987 to receive one afternoon Mr. at the laboratory. It was one great moment. It came surrounded by 5 or 6 people of the embassy and the latter seemed more to supervise it than another thing…

As much to tell you that he did not believe at all in the nor with the Clerc's Offices very short! As soon as I showed him a radiography of a patient with a , the first thing that he told me to make, it was to remove it! It was more one dialog of the deaf who an exchange of ideas. I compared osteotomy and during lengthening in the adult animal. I could show that between and osteotomy, there was no significant difference in the speed and the quality of consolidation of lengthening. The regeneration of the medullary artery is so fast that its interruption does not cause any concern for ossification. The quantity of cal was similar in the two groups. One could thus make an osteotomy without problem. The publication of this item had a certain repercussion and it was quoted many times in the surgical literature.

. : Which is your analysis of the success of compared to the preceding fixers?

: Before , there was the Wagner method which was about similar if it is not that one lengthened from the start of a half or cm the bone during the intervention. Lengthening of one cm is certainly very surgical but also more destroying for the vascularization of adjacent tissues. , proposed to him to make only one lengthening of a mm per day and if possible divided into two or four times over the 24 hours. is much more respectful of cellular physiology. Implemented correctly, it is an extraordinary method. I never saw as many osteoblasts on a histological cut in . It is superb! They are much more numerous than in an ossification by . Mechanical induction is higher than chemical induction but its implementation is more demanding.  It reproduces the philharmonic orchestra which ends in an ossification whereas chemical induction produces only one soloist, and it is all the difference there. The mechanical : it is long and constraining but it is nevertheless extraordinary.

. : What becomes the and the ?

: The joins the for reasons of logistics and target. The is a society where the fundamentalist ones and the surgeons meet around one or two precise topics of search in csotcina.comedic surgery. It is the occasion of an exchange with a more fundamental lighting for the surgeon. The they is the and the bone substitutes. This group was very active at the time or it was necessary to recognize the tissue banks. It was then with in the chair Bernard . The banks were recognized and Bernard became the Director of the French Establishment of the Clerc's Offices then medical director of the Biomedicine agency. I think there that one had a defender of choice for all that is and bone substitute. The then published several platelets on the bone substitutes, with like chair: , and now . The current aim of the , it is to sensitize the surgeon with the characteristics of the bone substitutes and to support search in this field. It is at the same time an educational mission and a stimulant of search. Association with the will accentuate this promotion of search by the meetings, the meetings and the discussions that together they will cause.