first stop: annecy - boston shoulder institute · • founded in 2006 by gilles walch & pierre...
TRANSCRIPT
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First Stop: Annecy
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Annecy
• Laurent Lafosse• Bruno Toussaint• Clinique Générale Annecy
• Private hospital• Lafosse CEO until recently• 145 bed hospital• Also has general surgery, OB/GYN, internal medicine and others
• Recently opened an ER
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The Lafosse Experience
• 5 fellows including me• UK, US, Spain, Austria
• Case log: 60 cases• Scrubbed on 21 of them• 12 arthroplasty• 44 arthroscopy• 4 others ‐ hand, elbow
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The Lafosse Experience ‐ Instability
• 4 arthroscopic Latarjet• 1 with posterior glenoid iliac crest grafting also
• 3 arthroscopic Bankart!• 2 with posterior labrum and SLAP repair also
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Latarjet
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The Lafosse Experience ‐ cuff
• 17 Cuff Repair• 2 with balloon• Almost always resected AC joint – done prior to cuff repair so as to maximize space to work on cuff and also so that there will be time to wash out all of the debris from the AC resection by the time you finish the case
• Often with biceps tenodesis into the anterior cuff
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The Lafosse Experience – other arthroscopy
4 isolated Suprascapular Nerve Release2 all arthroscopic CC Ligament Reconstruction2 arthroscopic Brachial Plexus Neurolysis6 isolated AC Joint Resection1 Capsular Release• Starts from subacromial space
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The Lafosse Experience ‐arthroplasty
5 TSA• 4 Depuy Unite• Reams humerus on power• Uncemented glenoid ‐ uses a syringe to collect the marrow extruded during humeral reaming & puts this around the flanged central peg but no cement & no bone graft
• 1 Biomet TESS resurfacing prosthesis for AVN post fracture in 60 y/o
1 Hemi• Depuy Unite
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The Lafosse Experience ‐arthroplasty
7 RSA• 6 Depuy Delta• 2 with lat dorsi transfer, anchor fixation
•1 of which was a revision from hemi in 66 y/o• 1 for proximal humerus nonunion in 63 y/o• 1 BIO RSA (Tornier)
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MAPs and Pump Pressures
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Geneva
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“Spider” à Lafosse
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“Class”
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Research
SFA Symposium for 2015Comparing arthroscopic (Lafosse) and open (Walch) Latarjet on CT scan immediately post‐op and at 6 monthsGraft position, healing, osteolysisPart of a larger groupEarly stages, measurement protocol to be
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The walk to work
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“Academic” Days
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Next Stop: Lyon
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LyonGilles WalchHôpital Privé Jean Mermoz• 268 bed private hospital• Ortho, general surgery, oncology, internal medicine, emergency room
Clinique Orthopédique Santy• Founded in 2006 by Gilles Walch & Pierre Chambat
• All members of the SOCOLY group (Société de Chirurgie de Orthopédique de Lyon) moved their respective practices and outpatient rooms to this
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Lyon
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Lyon
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The Walch Experience
One Italian visiting resident and one French medical studentTwo rooms once a week• Same two scrub techs every week• Typically 8‐9 cases by 5‐6pmCase log: 28 casesScrubbed on all of them5 open Latarjet18 Arthroplasty
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The Walch Experience ‐ Instability
“Butée” (meaning a “stop” or “block”)Usually not referred to as a Latarjet, especially in LyonMichel Latarjet was a general surgeonEarly 1950s, he attempts to perform a TrillatprocedureMistakenly breaks off the whole coracoidUnsure what to do, he pushes it through a split in the subscap & fixed it to the glenoidA d b
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bert Trillat0 ‐ 1988
Henri Dejour1930 ‐ 1998
Michel Latarjet1913 1999
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The Walch Experience ‐ InstabilityTrillat is aghast at Latarjet’s mistakeHe says he would never allow any of his students to perform such an operationIn 1984 one of these students, a young surgeon named Gilles Walch, returns from his one‐year observership with Jobe & RockwoodWalch believes from his observations that the Trillat procedure has a high failure rate
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The Walch Experience ‐ InstabilityTrillat is a mentor for Walch, giving him many private patients as he starts out in practiceHenri Dejour, the professor of orthopaedics, tells Walch that he is not allowed to do Latarjet’s operation “this is Trillat’s hospital”Walch persists and shows Dejour data on the Trillat procedure with a 30% rate of recurrence of instability; goes on to publish this in French
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The Walch Experience ‐ Instability
ev Chir Orthop Reparatrice Appar Mot. 986;72(8):541‐55.Anterior recurrent luxation of the shoulder. ostoperative recurrences].Article in French]Walch G, Charret P, Pietro‐Paoli H, Dejour H.
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The Walch Experience ‐Arthroplasty
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Rehabilitation in Lyon
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Merci