Dr Thibault Lafosse

Dr Thibault Lafosse Hand, Upper Limb, Brachial plexus, Peripheral Nerve Surgery, Microrovascular surgery, Arthroscopy

Shoulder surgeries videos now available on USB keys 🎞️Missed the 2025 Annecy Live Surgery Course? Want to review specifi...
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

In shoulder arthroplasty, we tend to stay with what we know.When a system delivers reliable outcomes and your team knows...
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?

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

I keep asking myself what the best RSA configuration really is.Listening to many peers today, it seems that 135° is the ...
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

post-op updateI proceeded in two steps.I started arthroscopically, with an extensive anterior extra-articular exposition...
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
Just back from the ASAP Meeting and wow — what a few days! Swipe for highlights from Snowbird 🇺🇸❄️I presented twice on R...
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!

Exactly 10 years ago, I was walking out of the hospital after almost 36 hours spent operating on the victims of the Nove...
16/11/2025

Exactly 10 years ago, I was walking out of the hospital after almost 36 hours spent operating on the victims of the November 13th Paris attacks.
I remember feeling dazed, confused, scared… and overwhelmingly sad.

During all those hours in the OR, one feeling never left me: I wanted to be somewhere else.
With my wife, with my kids.
I wanted to make sure they were safe.
I wanted to flee Paris.

No one knew what was coming next.
No one knew if it was over.
Calls from paramedics kept coming in, mixed with false alarms about new attacks.
Families and friends looking for missing loved ones were calling nonstop.
It went on all night, all day, all night again…

All that mattered to me was to finish operating on every wounded person we received, and then run to my family.

For months afterward, I couldn’t take the metro.
I didn’t feel safe anywhere in Paris — not even on the train leaving the city.
For years, I couldn’t talk about November 13th at all.

What few knew that night is that the patients I operated on were at the beginning of a long, painful journey:
years of surgeries, of débridements, flaps, bone grafts, external fixations…
Years before reclaiming a normal life.

Some of them eventually followed me to Annecy.
Together, step by step, we completed the last phases of their reconstruction.
In a way, accompanying them through this path was the only way to process what happened during those nights of November 13th and 14th, 2015.

Ten years later, I still remember every detail of those days, and of the months and years that followed. They have shaped me forever.

But I am lucky — still today — to remain in contact with several of these patients, survivors of the attacks.
And what they represent is, to me, the strongest possible victory against terrorism:

They live.
They live full lives.
Which means they won.

10 years ago, at the end of my training in Paris, I took six months off, packed my family, my savings — and left for Tha...
12/10/2025

10 years ago, at the end of my training in Paris, I took six months off, packed my family, my savings — and left for Thailand.
Four months of fellowship in peripheral nerve and microsurgery that changed everything.
It shaped the surgeon I’ve become, but also the person.

I was hosted by Dr. Somsak himself at Lerdsin Hospital, in Bangkok — an experience that opened so many doors.

This week, I had the chance to host one of the fellows I met there.
That’s what traveling to learn is really about: sharing, passing on, and pushing boundaries together.

It was a pleasure to meet again thanks to , and to plan future exchanges between the Alps Surgery Institute and Lerdsin Hospital.
Life goes on — and that’s the best part

What a cool day yesterday with our young surgeon, who comes to help us out with the many cases we have to deal with at t...
10/02/2024

What a cool day yesterday with our young surgeon, who comes to help us out with the many cases we have to deal with at the hospital! Including the hand trauma!!!
Still learning from the master 😍

Going to Afghanistan was one of the most unbelievable medical experience I ever lived. It was already a while ago, but I...
07/01/2024

Going to Afghanistan was one of the most unbelievable medical experience I ever lived. It was already a while ago, but I dream of going back… Kabul is a fantastic place with amazing people, and incredible doctors, many of which are doctors, nurses….

https://www.bbc.com/afrique/articles/c3gy320r11go

Today my father was back in the OR, next door, next room, operating on crazy cases. It felt like the old days.He is back...
15/12/2023

Today my father was back in the OR, next door, next room, operating on crazy cases. It felt like the old days.
He is back for a while substituting one of my partners for a few months.
I have worked so much since I was a med school student to have the opportunity to work with this man.
I was lucky to share my 5 first years of practice as a surgeon with him, to have him everyday nearby to continue learning from him.
Now he’s retired, we share even more.
I wish all of us, passionate by what we do, to retire the way he does… being back in the OR every time he gets a chance. Teaching youngsters, giving patients the best of his knowledge and experience. I was always under his spotlight, and for this,I am the luckiest surgeon in the world.

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