Made in France – Modern Orthopedics

The Fathers of Modern Joint Surgery: Robert and Jean Judet

Born to an orthopedic surgeon father, brothers Robert and Jean Judet became two of the most influential surgeons, researchers and teachers in the history of orthopedics.

In 1932 the brothers worked together at the Hôpital Lariboisière in Paris and were already publishing articles which described how to treat fractures by using external fixators.

While working with Bernard Desplas, Robert Judet suffered an injury to his right hand that threatened to end his surgical career. Desplas, employing the most advanced techniques of that time, saved his colleagues hand—if not also the future of hip surgery.³

In 1937 Robert Judet began focusing intensively on orthopedics when he took the position at the Hôpital Cochin in Paris. World War II interrupted his role at head of the Cochin clinic, however, and Judet took part in a mobile surgical unit during the Battle of France. His conduct earned him the CroixdeGuerre avec l’Étoilede Bronze (War Cross with Bronze Star).⁴

When the Germans occupied France, both Judet brothers contributed much to the Allied cause, treating American and English parachutists. They used blood plasma transfusions, closed and semi-closed-circuit anesthesia, techniques that came from America via an Army base in North Africa. For their dedication, each of the brothers was honored with the Médaille de la Résistance (Resistance Medal).⁵

Upon demobilization, Robert Judet was awarded the CroixdeGuerre avecPalme(War Cross with Palm), becoming the only surgeon to be so honored. In 1945 he was made Chevalier de la Légion d’Honneur (Knight of the Legion of Honor), becoming an officer in the Legion of Honor in 1957.⁶

*Robert and Jean Judet / Courtesy of pmj.bmj.com/content/postgradmedj/28/321/412.full.pdf*

In 1946 “Team Judet” revolutionized hip surgery by using the first acrylic prosthesis in a femoral head replacement, in 1952 publishing on 400 cases with positive results. The brothers, who masterminded the anterior approach to the hip, in 1947 performed the first such hip replacement in Paris, using a Judet acrylic prosthesis. The “Judet Table,” designed by Robert’s orthopedic surgeon father Henri, was specifically designed for the anterior approach to the hip, an approach that turned the tables on the popular posterior approach.

Robert Judet took over as Chef de Service at the Hôpital Raymond Poincaréin Garches in 1956, transforming what was little more than a service for the chronically ill into a true orthopedic and traumatology institution with a worldwide reputation.⁷

In the early 1960s the Judet brothers turned their attention to the issue of non-unions, developing a technique known as osteoperiosteal decortication. The process involved using a sheath comprised of vascularized bony strips that helps to stimulate the bone healing process. Judet stated that “by elevating cortical chips that remain attached to the periosteum and overlying soft tissues surrounding the site of non-union, combined with mechanical support, the bone consolidated.” Their technique remains viable in the modern era, with researchers publishing in 2012 that “osteoperiosteal decortication remains a highly effective surgical technique in the management of failed fracture union.”⁸

Observing the high rate of cemented hip failures, Robert Judet undertook a mission to investigate other options, culminating in his development of the Porometal cementless hip prosthesis in the early 1970s. The concept was to have the bone and metal in as direct contact as possible, with sufficient surface irregularities to promote bony ingrowth. Also critical was that Judet obtained a solid head-neck fixation via use of a Morse taper. It was, according to Judet, “A metal that welcomes the bone instead of a cement that violates it.”⁹

When Robert Judet passed away in 1980, the famed English surgeon Sir John Charnley wrote, “France has produced many important orthopedic surgeons, but among them, Robert Judet is certainly the most well-known.”¹⁰

Postscript

As Dr. Rosset reminds us, “So many innovative prostheses originated in France. In 1963 Raymond Roy-Camille performed the first spine fixation using transpedicular screws and plates. Paul Grammont revolutionized orthopedics in 1970 with his reverse shoulder prosthesis…and many more which you will address in your upcoming articles.”

Sofamor, the French spinal implant company, merged with the U.S. firm Danek in 1993 and created the largest supplier of spinal implants and instruments which, today, is known as Medtronic Spine. Still the largest supplier.

Tornier, the French shoulder and extremity implant company, is now part of the $3.3 billion Wright Medical Company.

Pro-Disc, the most commonly implanted lumbar motion-preserving spine disc, is a French innovation. MOBI-C cervical discs, the most commonly implanted cervical motion-preserving spine discs—another French innovation.

It goes on and on.

If you have an example of French orthopedic technology and innovation, please post a note following this article.

Je vous remercie!

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