Dr Thibault Lafosse

27/04/2026

A massive congress.
A huge applause to
A different energy.
A different way to think shoulder surgery.

Not everything resonates.
Not everything should.

That’s the point.

Europe builds with rigor.
The US moves with speed… and conviction.

Some ideas feel unfamiliar.
Some feel uncomfortable.
Good.

Because comfort rarely means progress.

Grateful for the discussions,
for the vision carried by Zimmer Biomet at a key moment,
and the opportunity to engage directly, beyond the stage,
and to exchange directly with Yvan Tornos.

Something is building.
You can feel it.

The question is not whether to follow.
But how you choose to be part of it.

18/04/2026

/ ASI live surgery course!

3 days. 100% live. No filters.

Real surgery. Real examination.
Complex cases… sometimes pushing the limits.

Open discussions around difficult / catastrophic situations.
No shortcuts. Just experience, doubts, and shared thinking.

Humility at every step.
Because that’s where progress starts.

Proud of the collaboration between Zimmer Biomet Institute & Alps Surgery Institute

Exceptional faculty
Outstanding fellows

On the way to ALS 2027!

14/04/2026

Multiple failed surgeries. Progressive loss of function. A forearm that no longer rotates.

This patient had a complex nonunion of both forearm bones after an open fracture initially treated with external fixation, then plate and screw fixation.
Over time:
- The radius shortened
- The ulna became relatively too long
- Pronation and supination were blocked

At ASI, we routinely manage complex bone loss with free osteocutaneous flaps.
Free fibula is our first choice for defects over 7 cm. Below that, the medial femoral condyle is a reliable option.
In this case:
→ Radial reconstruction with medial femoral condyle
→ Ulnar shortening

➡️ Swipe to see the preop imaging, surgical steps, and at the end, postop result.

This is the kind of reconstruction that reminds us why microsurgery remains part of our core practice.

06/04/2026

When life truly matters…

Back to the roots.
Africa.
Microsurgery.
La Chaîne de l’Espoir.
Friends.
My mentor.

Abidjan, again.
And that familiar fire, still there.

These kids…
Their strength.
Their smiles.
The energy. The people.

It gets under your skin.

Can’t wait to go back

17/03/2026

Three intense days in Annecy for the 24th Stryker ASI Shoulder Arthroscopy Course 🏔️

Learning, debating, operating. That was the rhythm.

Day 1: Live patient exams and open discussions on complex cases. We debated indications, strategies, and treatment options with faculty and participants.

Day 2: Operating room time. We performed live surgeries at the clinic, broadcast in real time to the cinema theater. Surgeons could follow every step and interact with us during procedures.

Day 3: Practice. Hands-on workshops on cuff repair, instability, and knot tying.

Real pleasure to operate alongside my father, Dr Laurent Lafosse. And a big thanks to Raul Barco and Andreas Voss for their contributions and the great exchanges throughout the course.

A special moment on Saturday: we invited female fellows to a self-defense session. Something we wanted to offer beyond the surgical program.

Thanks to .orthopaedicinstruments for their continued support in making this course possible. And thanks to all participants and fellows for the energy that made these three days valuable.

Looking forward to seeing many of you again in Annecy!
What was your key takeaway from the course? 👇

10/03/2026

Shoulder surgeries videos now available on USB keys 🎞️

Missed the 2025 Annecy Live Surgery Course? Want to review specific cases?

These USB drives contain exclusive live surgery recordings from our International Shoulder Advanced Courses in Annecy. Each video shows advanced shoulder techniques with real-time commentary on key steps, surgical tips, and intraoperative decisions.

What’s inside:
- 35 full-length videos
- Unlimited replay access
- Complex procedures with live commentary
- Ready to use as reference for your practice

Perfect for reviewing critical maneuvers, refining your technique, or preparing specific cases!
🔗 Order yours through the link in my bio

02/03/2026

In shoulder arthroplasty, we tend to stay with what we know.

When a system delivers reliable outcomes and your team knows it well, you build confidence. So why change?

Two weeks ago, I had the chance to implant several cases with the Identity system is launching in Europe. I even performed one of the first European anatomic Identity cases here in France.

The system has been used in the US for years by colleagues I respect. Their feedback made me curious.

First impression? Very positive.
The instrumentation is intuitive. The ancillaries are simple and well designed. The workflow feels precise and efficient.

It doesn’t try to revolutionize everything. It refines what matters.

Early experience is encouraging. Happy to have it fully available in my practice now.

I’m curious to hear from colleagues with more experience on it. What’s your opinion?

17/02/2026

I keep asking myself the same question before rTSA in ER-deficient shoulders: Am I right to actively restore external rotation?

Is the risk of complications higher? Or is lateralization alone enough?
Preoperative ER lag sign is an important argument. But it is not the only one.

Intraoperatively, when I find a greater tuberosity completely bare - no tendon attached - I worry. Even if preoperative ER is borderline, I fear a postoperative lag sign.

And honestly, in the past, I have more than once regretted not performing a latissimus dorsi transfer in some of these patients. Good elevation. Good implant position. But persistent active ER deficit.

They rarely want to go back to the OR… And I do not like that situation.

So we looked at our own mid-term results after combining reverse shoulder arthroplasty with isolated latissimus dorsi transfer, in order to thoroughly question our practice from an evidence-based medicine standpoint.

📖 Our paper has just been accepted in the Journal of Orthopaedics and Traumatology.
 🔗 Link in bio.

Mean follow-up: 4.8 years
• 95.5% ER lag resolution
• ER improved from −13° to +10°
• Constant: 32 → 71
• SSV: 30 → 80
• No revisions
• No complications

This algorithm is, of course, a hot topic.
But this study reinforces my confidence in adding a tendon transfer in selected CLEER patients, including based on intraoperative findings.

I am genuinely interested in knowing which approach is currently most widespread among shoulder surgeons.
Do you add a tendon transfer? Or rely on implant design alone?

Let’s discuss 💬

10/02/2026

I keep asking myself what the best RSA configuration really is.

Listening to many peers today, it seems that 135° is the way to go.
Better rotations, less notching… at least in theory.

However, in my own practice, I have always been cautious with very low neck–shaft angles.
I fear acromial fractures, instability, and above all, I have been very satisfied with my clinical results using Grammont-style systems.

So instead of following a trend, I wanted to push the analysis further.

Together with my father, Dr. Laurent Lafosse, we performed a large computational study:
- 104 CT scans
- 5 different RSA plannings per shoulder
- 520 preoperative simulations compared

🔍 What did we find?

Lowering the NSA from 155° to 145°:
- Significantly improves adduction and helps control notching
- Provides very good internal and external rotations
at the cost of some loss of abduction

Most importantly, this study shows that excellent rotations can already be achieved at 145°, without necessarily pushing the system toward more extreme biomechanical configurations.

For me, this reinforces the idea that 145° may represent a very reasonable compromise — between mobility, stability and long-term safety.

📖 Decreasing the neck shaft angle from 155° to 145° improves adduction, but reduces abduction – A CT simulation study

💬 I’m curious to hear your experience:
do you routinely go to 135°, or do you also aim for a balanced approach?

👉 Comment “NSA145” and I’ll be happy to share the full paper

30/01/2026

post-op update

I proceeded in two steps.

I started arthroscopically, with an extensive anterior extra-articular exposition to be able to approach the joint, did a thorough intrarticular release, which allowed reduction of the posterior dislocation — honestly the most challenging part of the surgery.

Still arthroscopically, I performed a posterior bone block using allograft to address posterior instability.

I then converted to an open approach to fill the reverse Hill-Sachs lesion using a humeral head allograft, fixed with two buried compression screws.

To achieve optimal exposure of the defect and ensure a reliable and solid subscapularis repair, I chose a lesser tuberosity osteotomy over a subscap tenotomy, and repaired using anterior and posterior sutures, anchors, and two screws.

Post-operative CT scan makes me happy! 🥳
Now, time will tell regarding the clinical outcome.😬😬😬

30/01/2026

29/01/2026

Just back from the ASAP Meeting and wow — what a few days! Swipe for highlights from Snowbird 🇺🇸❄️

I presented twice on Reverse Shoulder Arthroplasty strategies, alongside Dr. .portes :
1️⃣ Soft tissue-only revisions for poor rotation and elevation after RSA: the real deal or all hype?
2️⃣ Maximizing internal rotation after RSA

But honestly? The best part was the conversations.
Real debates. Questions that challenge how you think. Research that makes you go « wait, I need to reconsider this. » That’s the energy I love about these meetings!
Oh, and between sessions... the slopes delivered ⛷️

Huge thanks to , , Bob Tashjian and the whole crew for bringing this community together!