French innovations in upper limb surgery that has become gold standards

France has significantly contributed to the development of upper limb surgery over the past century. Although several French techniques and implants are now used worldwide, their historical origin, their technical evolution and the level of evidence supporting their status as "gold standards" have rarely been gathered. This narrative review aims to analyze from a short historical point of view with long-term published evidence of French innovations in shoulder, elbow and hand surgery that have achieved international reference status.

This narrative review will cover four domains of upper limb surgery where French innovations have reached the status of gold standards: shoulder instability (Latarjet coracoid transfer), shoulder arthroplasty (Grammont reverse prosthesis, Walch glenoid classification, 3D planning, patient-specific instrumentation and navigation), the elbow (GUEPAR total elbow, bipolar radial head arthroplasty) and the hand (trapeziometacarpal arthroplasty). For each innovation will be summarized, the original description, the evolution and the actual evidence. Priority was given to systematic reviews, meta-analyses and cohorts with the longest follow-up. Outcomes were reported according to the usual relevant data for each type of surgery.

The Latarjet procedure (Lyon, 1954) provides durable stability, with less than 10% recurrent instability and more than 85% return to sport at long-term follow-up, at the cost of frequent glenohumeral osteoarthritis. Malposition of the bone block is the main modifiable risk factor with late arthroscopic variant which has not reached the same adoption. Grammont's reverse prosthesis (Dijon, 1985) gave the solution to cuff-tear arthropathy by medializing and distalizing the center of rotation. The Walch classification (1999) and French-born 3D planning, patient-specific instrumentation and navigation achieve glenoid positioning within approximately 1 mm and below 5° of error. At the elbow the contribution was more modest: Judet's CRF floating-cup implant, the first bipolar radial head prosthesis, gave satisfactory long-term results (mean DASH 18.7 at 87 months) comparable to monopolar implants, with both still being used. In the hand, trapeziometacarpal arthroplasty, initiated by de la Caffinière in 1974 and refined through four generations to dual-mobility bearings, now shows more than 90% survival at 10 years, has overtaken trapeziectomy in France and is gaining worldwide momentum by obtaining US regulatory approval in 2026.

France has taken a significant part of nowadays gold standard in upper limb surgery. Most decisively at the shoulder, where coracoid bone-block, reverse arthroplasty and digital 3D planning are established worldwide standards. At the hand, trapeziometacarpal arthroplasty is emerging as the next international gold standard backed by strong long-term evidence, now expanding in the USA. The elbow illustrates a mixed adoption with radial arthroplasty coexisting with other designs.

V; expert opinion.