EHS Travelling Fellows Goksel Dikmen (Turkey) and Oleksii Tankut (Ukraine)

Dr Goksel Dikmen writes…

First of all, I would like to state my deep gratitude to the ExCom of EHS, and the Chairman of the EHS EduCom, Prof Ullmark for selecting me and giving me the opportunity to be a part of highly valuable clinical fellowship. Also, I would like to thank my chief Prof Remzi Tözün & National Representative of our country Prof Mazhar Tokgözoĝlu for their great care and support. In addition, I’d like to thank the European Hip Society for funding this Fellowship and last but not least, I’d like to thanks Mrs Samantha Stokes for her great help.
Planning started immediately after receiving the good news that I had been selected to participate in this great fellowship. We made some arrangement for work and travel to France; before the travelling, host clinics made some recommendations for local stay and travel within France between centers. The fellowship was shared by the three centers depending on the availability. We started the fellowship in Marseille, then passed to St Étienne in the second week and we finished the fellowship in Quimper (Brittany) at the North Pole of France.

1st Week-May 29th to June 3rd: Marseille
Prof J N ARGENSON Hospital Sainte
Marguerite, Marseille Cedex
During the first week in Marseille, we had a chance to see the working style of Prof J N Argenson and his team in the Hospital Sainte Marguerite. Prof Argenson is a very busy surgeon, chief of the clinic, who spends most of his time on hip and knee arthroplasty, some trauma cases and also the set-up of the 2nd World Arthroplasty Congress, which is organized by EKS, EHS & ICJR in 2018. Prof Argenson and his team have, for over the years, experienced the patient specific implants for total hip arthroplasty. We had theatre sessions with Prof Argenson on one day. We learned some tips and tricks for supine position-anterolateral approach and how to prepare the femoral canal for a custom made femoral stem.

We had a scientific meeting and staff meeting prepared by Sainte Marguerite resident team (the youngest resident and a last year resident gave us lectures about femoral and acetabuler defect in revision total hip arthroplasty) at the end of the first day of the fellowship.

We had a chance to watch direct anterior approach with Prof Pinelli in the other two days of theatre session. The teamwork the surgical team exhibited was very evident in OR.

We ended the second surgery day with a very special lunch with Prof Argenson and Dr Parette at La Villa restaurant in Prado. We also witnessed some hip revision cases and primary hip & knee prosthesis, high tibia osteotomy with patient specific cutting blocs by Dr Sebastien Parette and Dr Xavier Fletcher. In addition, Dr Xavier showed us some hip arthroscopy cases for FAI patients in the Hospital Nord, which is the north part of Marseille.

On the last day of the first week we visited the biomechanical laboratory of Sainte Marguerite and learned of the upcoming research activities, we also observed the design of custom made prosthesis for scheduled patients with PhD students.

Friday afternoon and Saturday, we had a chance to visit some historical places in Marseille and the most beautiful cities of Provence – Nice & Cannes, and also Monte Carlo and Monaco with Oleksii.

2nd Week-June 5th to June 10th: St Etienne
Dr F FARIZON (Dual mobility cups)
Hospital Nord du CHU, Saint-Priest-en-Jarez
On the 2nd week of the Fellowship, we arrived at St Etienne by train on Sunday afternoon. The first day of the week was the national celebration day of France (5th of June), because of that we meet some residents in the Hospital Nord orthopedics service and learned the weekly OR program, and visited the historical places of St Etienne.

On the second day, early morning, we met Prof Frederic Farizon and his team in the staff meeting. Prof Farizon is an accomplished surgeon; an excellent chief and shows great care for all residents and all cases of the operating room, he is also a key researcher for the dual mobility concept. Prof Gilles Bousquet -the surgeon who first entered research and development phases, and worked on dual mobility design – was the chief of Prof Farizon.

We had a chance to see some primary and revision cases of dual mobility cup. I’d like to say a special thanks to Prof Farizon for letting us scrub for all procedures with him during our two days. He shared his knowledge very carefully and explained, at every stage, precisely how he was acting. The positive attitude and teamwork of Hospital
Nord was a delight to watch. Posterior approach was the main approach; we learned some tips and tricks from Prof Farizon about how to apply dual mobility systems. We also had the chance to see an old Bousquet cup (tripod revision (18 years)) this was very interesting, because we did not observe linear wear in the old polyethylene with a 22.2 mm metal head -the revision reason was femoral neck & head material mismatch, not the poly wear (Taper corrosion).

The next day in OR, we assisted Prof Remi Philippot with primary and revision hip arthroplasty. The last evening, we had a scientific meeting; Prof Farizon’s team and other orthopedic surgeons from the different hospitals of St Etienne made some presentations about knee osteotomies and unicompartmental knee arthroplasty in the physical therapy department of Saint-Priest-en-Jarez, after which an official dinner followed with traditional St Etienne kitchen foods.

The following day, in the morning, we left this lovely city with lots more knowledge and friends.

3rd Week-June 12th to June 17th: Quimper
Dr F GAUCHER (DDH sequelae)
Centre Hospitalier B.P. 67, Lannec Hospital
From St Etienne I travelled by train with Oleksii to Quimper where Prof François Gaucher was our host. Quimper is the capital of the “department” of Finistère and is known as the French Conrnwall (“Cornouaille”) – it is the northwest part of France that is the called Brittany region. Also, Quimper is a well known area for congenital hip disease between French orthopedics surgeons.

On the first day of the week, we met Prof Gaucher in the orthopedic service of Hospital Lannec; Prof Gaucher planned two separate video presentations about femoral shortening osteotomy, cemented fixation techniques with and without trochanteric osteotomy in high hip dislocated patients. Also, he gave us a lecture about the French classification of DDH (Cochin) and we discussed the other classification systems and techniques after presentation.

On the second day of Quimper, we scrubbed up with Dr Philippe Brunet; we learned some tips about anterior and posterior approaches from him, and learned some new
knowledge about anatomical dual mobile cups, which are designed to decrease iliopsoas impingement of large poly heads.

On the third day of week, there was no operation; Prof Gaucher arranged a small trip around Brittany, and took us for a delightful tour with his car. We saw the famous Pointe du Raz, which is one of Brittany’s most popular natural sites. We climbed and walked this intriguing island with Prof Gaucher and then lunched in Hôtel Restaurant de la Baie des Trépassés, with the beautiful view of the Atlantic Ocean and Pointe du Raz.

Thursday, we scrubbed up with Dr Yann Cotonea for knee osteotomy and knee revision case for combined ligament insufficiency after cementless CR total knee arthroplasty.

On the last day of the Quimper and also our fellowship, we had two operations with Prof Gaucher. I had a chance to see direct lateral trans-trochanteric chevron osteotomy for acetabuler reconstruction with femoral head autograft and cemented femoral stem application in dysplasia sequel; it was a very nice experience to see such a difficult case for reconstruction.

Prof Gaucher is also interested in pediatric hip surgery, and in the second case, we made a cannulated screw for a slipped capitis femoris in young male patients. I’d like to give special thanks to Prof Gaucher for letting us scrub for all procedures with him and for sharing his experience with us, and thanks for the hospitality of the Lannec orthopedic service during five days.


In summary, what can I say?
One of the special aspects of a Travelling Fellowship ino France is that every city is entirely unique and offers a completely different experience. The Travelling Fellowship was a once in a lifetime experience. I want to thank again EHS and the ExCom of EHS, EduCom of EHS, and all our hosts and for organizing everything so very well.