• EHS: Professor Henri Migaud, who are you, and how can you introduce yourself as an Orthopaedic Surgeon?
HM: I am a French orthopaedic and trauma surgeon, at the head of the orthopaedics department of the University Hospital in Lille. My activity focusses chiefly on total hip arthroplasty (THA). Our institution is a referral centre serving 3 million people and performing over 800 primaries THAs and about 200 revision THAs each year. A large part of the revisions is done to treat the infection. In 2008, the French health authorities decided to designate nine referral centres, based on stringent criteria, for patients with prosthetic joint infections. Lille was the first centre to be selected. These centres – which also handle other forms of complex osteoarticular infections and are known as CRIOACs – have their accreditation revised every four years; the conferring of accreditation results in improvements in quality of patient care. The nine CRIOACs are distributed evenly throughout the country.
I am also a knee surgeon predominantly involved in knee arthroplasty revisions, whose number is growing rapidly in France (by 20% increase per year over the last five years). The number of hip revisions is currently stable thanks to close monitoring of flaws in design and technique and despite the absence of a reliable national arthroplasty register: less than 10% of the 120 000 THAs performed in France each year are entered into the French register handled by the French Society for Orthopaedic and Trauma Surgery (SoFCOT) . For hip resurfacing procedures, in contrast, the French health authorities mandated a specific register in 2015, allowing this procedure to be performed in only a few designated centres by surgeons specifically trained in Lille by Julien Girard. The register thus includes all cases, showing a number of about 250 per year. Hip resurfacing is currently performed at our institution in carefully selected patients (most of whom are males with primary hip osteoarthritis and a femoral head larger than 48 mm). All these patients are entered into a National hip resurfacing register.
Although conservative procedures such as hip-shelf acetabuloplasty, Chiari osteotomy, and proximal femoral osteotomies are also performed at our institution, their indications are declining due to the excellent outcomes of THA, even in younger patients. Other conservative procedures are being increasingly performed, including arthroscopy and the Hueter anterior approach to treat synovial conditions and perform cartilage repair. Finally, some patients require revision after conservative procedures, a situation in which work done with Gilles Pasquier and Sophie Putman supports 3D custom implants as a viable option. In these situations, EOS imaging, available in Lille since 1998, is helping to improve measurement accuracy.
• EHS: Do you also get involved in scientific matters and clinical research in Orthopaedics?
HM: Research at our institution travels along three main avenues: 1) Kinematics and biomechanics with the help of engineers (Ecole Nationale des Arts et Métiers, Ecole Centrale de Lille); we investigate hip and knee kinematics, notable differences in kinematics and proprioception between THA and hip resurfacing, and we also have a large collection of hip component retrievals, which we assess for complications related to mechanical and material failures; 2) The biological inflammatory response to avascular necrosis of the femoral head (with the help of Laboratory “Physiopathologie des maladies osseuses inflammatoires” - EA 4490) and the consequences of implant corrosion and failure (blood ion levels in primary and revision THAs and hip resurfacing) (with the help of the Laboratory “Impact de l'environnement chimique sur la santé humaine” - EA4483); and 3) Long-term clinical outcomes, as well as short-term outcomes of new designs, for which
information is available from our hospital database. We also conduct numerous clinical studies of the
management of infected THAs (our institution started performing single-stage surgery for THA infection in 1985, well before this strategy became popular, even in Europe). With the help of Eric Senneville and Caroline Loiez from our CRIOAC team, we investigate new tools designed to improve the diagnosis of infected THA and the assessment of bacterial resistance.
During the 1980s, we used impaction bone grafting to treat bone loss in revision THA, modifying the original Exeter stem technique by adding a metallic mesh to protect and reinforce the graft at the femur (between the graft and the cement facing the bone loss). The outcomes of this modified technique were reported at many combined meetings of the EHS and EFORT. In revisions for infection, we also investigate the use of new antibiotics as well as new strategies for administering established antibiotics (e.g., oral administration either immediately or after only brief intravenous treatment, shorter antibiotic courses, etc…).
I am currently a deputy editor of Orthopaedics & Traumatology: Surgery & Research , the official journal of the SoFCOT, which was launched in English in 2009. I have been a member of the European Hip Society since 1997 and of the International Hip Society since 2012. Finally, Jacques Witvoet and I promoted the foundations of the French Society for the Hip and Knee (SFHG) in 1997 .
• EHS: What about your involvement in the European Hip Society, and the next International Congress in 2020 taking place in Lille, France?
HM: My friend Jean Alain Epinette, the current EHS president, asked me two years ago to help organise the 2020 EHS meeting in Lille, and I am very pleased to provide as much assistance as I can. Jean Alain was trained in Lille, and we agree on many topics. I have known him for years and am confident that he will promote open-mindedness with free debates and an objective approach to the many controversial issues.
I have never participated in organising an EHS event, despite being a member since 1997. I am delighted to contribute to the life of our society and particularly proud to welcome the EHS in Lille. Our city is a major European centre, with an abundant transport network and clear evidence of historical influences from Spain, The Netherlands, and the UK. French hip surgeons are not usually very active in the EHS, although Jean Alain Epinette and Jacques Tabutin are exceptions.
Jean Alain and I will promote the EHS and its 2020 meeting through the SoFCOT and SFHG. With the drive provided by these organisations and the help of the EHS Scientific Committee (SciCom) chaired by my friend Luigi Zagra, I am confident the 2020 EHS meeting in Lille will be a striking success. This meeting will be twinned with a meeting of Hip Toulouse and will have Canada as the guest nation, thus strengthening our links with the south of France and with our Canadian friends particularly from the “Belle Province”.
1 - Centres de Référence pour les Infections Ostéo-Articulaires Complexes (Referral Centres for Complex Osteo-Articular
2 - Société Française de Chirurgie Orthopédique et Traumatologique
3 - The former name in French was Revue de Chirurgie Orthopédique et Reparatrice de l’Appareil Locomoteur.
4 - Société Française de Chirurgie de la Hanche et du Genou, SFHG