French Innovations in Lower Limb arthroplasty that have Become "Gold Standards": an overview

This paper aims at reviewing some of the major French innovations in lower limb arthroplasty. This achievement could happen only through substantial efforts from pioneers that understood they had to adhere to the general principles of research through well designed studies, robust evaluation tools, and long-term follow-up studies. One of the major inventions in total hip arthroplasty (THA) was dual mobility cups (DMC). The concept of DMC has clearly demonstrated clinical efficiency in the prevention and treatment of postoperative dislocation both in primary and revision THAs. Another landmark progress in THA was introduced through alumina ceramic bearings. This material has exceptional tribological properties leading to an extremely low volume production of wear particles. Concerning major bone defects in revision THAS, Marcel Kerboull introduced a reinforcement device that could bridge the inferior margin of the acetabulum to the ilium in association with bone reconstruction using allograft. The reported results have been favorable, and together with DMC, this type of construct has become largely diffused internationally, in particular in Japan. Another topic that has emerged from France is related to total ankle arthroplasty (TAA). Major progress was made in the mid-90 s including a keeled tibial component, talar resurfacing, and a mobile PE insert. The French TAA registry also represents a major advancement demonstrating the French contribution to the development of TAA. In total knee arthroplasty (TKA), an original approach was introduced by the Lyon school of surgery through the third condyle concept to reproduce knee kinematics and reduce complications related to the post-cam mechanism. This design provided favorable clinical outcomes and high survival, and was the basis of modern implants and personalized knee arthroplasty. Also an innovative fixed-hinge TKA, the GUEPAR, was designed by French surgeons in the 1970s with further versions to deal with complex situations. However, due to specific complications related to the use of polyethylene and later metallic bushings and to the transverse axle, fixed-hinge TKAs were progressively abandoned and currently replaced by rotating-hinge designs. These examples demonstrate the extremely active participation of the French orthopaedic community to the development and knowledge of lower limb arthroplasty in order to provide the patients with optimal care. LEVEL OF EVIDENCE: V; expert opinion.