After my arrival in France, I first stayed in Lyon for six weeks where I received guidance from Dr.Cartillier of Clinique Mutualiste and Dr.Caton of Clinique Emile de Vialar.

Dr.Cartillier heads the Artro Group composed of seven orthopedic surgeons and has used from 1986 their original HA coated prosthesis called Corail. He has successfully maintained a survival rate of 95% in the past 9 postoperative years. As surgical approach, they without separating the great trochanter in the lateral position select either the posterior or anterior approach depending on the age and sex of the patient. It is matter of regret that I was unable to observe their procedure, but they have their original cementless cup for revision called Octopus. Dr.Caton has initiated from 1979 Charnley's total hip arthroplasty and performed this procedure on 3,000 cases to date. The prosthesis is not an original of Charnley, but is fabricated in France adding thereto a cement spacer and modular neck. The out-standing features of this operative technique is the non-touch technique with no direct hand contact with the operative field together with minimal bleeding and short operation time of about 65 min. Though the prosthesis differs, the operation of the two was extremely systemic using only a few operative instruments and invoIving a short operation time. I was strongly impressed that this may the ideal procedure for total hip arthroplasty.

During my stay in Lyon, I enjoyed warm hospitality from Dr.Picault, honorary president, Professor Kohler, vice president, Dr.Lorge, Dr.Chassard and Mrs.Girin in addition to Dr.Cartillier and Dr.Caton. I am most appreciative of this excellent hospitality extended to me at the headquarters of this Society. Furthermore, before my departure from Lyon, Professor Kohler kindly provided me a rare opportunity of making a presentation on basic research and clinical results concerning rotational acetabular osteotomy. After my presentation, I received a large number of questions and comments from my audience. My paper on this basic research was submitted toArchives of Orthopededic and Trauma Surgeryprior to my departure to France and upon my return to Japan a notification of acceptance of my paper for publication was received from the journal editor. It is most fortunate for me that I could mention this in my letters of thanks.

During the remaining six weeks I received education and training at Hospital Cochin, the attached hospital of Paris Sixth University, the alma mater of Professor Merle d' Aubigne and Professor Postel. It is not an overstatement to say that it is a representative hip center of France where 600 cases of total hip arthroplasty (400 primary cases and 200 revision cases) are performed each year. Here I received guidance from Professor Courpied and Professor Kerboull, chairman of the Department of Orthopedic Surgery. Iwas afforded the opportunity of observing total hip arthroplasties with the prosthesis of Charnley-Kerboull type having a stem length longer than the original and reduced neck-shaft angle, and observing many cases of revision using support ring called Kerboull plate. In the revision, one or two frozen femoral heads were used and massive bone allografts were also sometimes required. The importance of bone bank was re-appreciated. For the prevention of non-union of great trochanter in Charnley's total hip arthroplasty, Professor Courpied always employs the digastric approach in which osteotomy of the greater trochanter is made for continuity of gluteus medius and vastus lateralis. This is considered to be a remarkably useful procedure in revision. Cochin's total hip arthroplasty cannot be said to be a truly new technique, but it is a very reliable technique supported by a long tradition and favorable long term results.

The hip joint surgery of France is characterized by the following features. Hardly any osteotomy is performed for functional reconstruction of the adult hip joint. As for prosthesis of total hip arthroplasty, the ratio of cement type to cementless type is almost comparable. Imported prothesis is not used without improvement and originals are used (about lOO types are available in France). France being a country with a long history of orthopedic surgery, there are a large number of useful operative instruments and tooIs in France which have not yet been imported to Japan.

I firmly believe that my participation in the training program will be a lifetime asset to me in that I was able to gain knowledge on hip joint surgery which can never obtained in Japan and to have become acquainted with many teachers and colleagues in France. I sincerely hope that this exchange training program will be further strengthened and promoted in the future and that I as a member of the society can cooperate in and support in my own way the program of the Society. Last but not least, I wish to express my profound appreciation to President Courpied, President Shichikawa and others of the French-Japanese Orthopedic Society for affording me an opportunity of participating in the useful and valuable training program.