1. EHS: Professor Philippe Chiron, who are you, and how can you introduce yourself as an Orthopaedic Surgeon?
As a French surgeon who practices orthopaedics and trauma at Purpan Hospital, Toulouse University Centre, I have been a University Professor since 1996; I was head of the trauma orthopaedics department which brings together all the previous departments of Toulouse, from 2015 to this year. This department has 147 beds, 12 of which are continuing care, to which are added 27 outpatient surgery beds; 7 operating theatres are dedicated to orthopaedic and three to emergency or deferred trauma. On the whole, 9,800 patients are operated each year in this department by 18 surgeons and 22 residents/fellows. The premises are recent (2014) and adapted to quality care.
I belong to a generation that has taken care of all trauma and orthopaedics regardless of the location of the lesions; Since the merge of the various services to a single emergency reception for Toulouse and its region, the surgeons have specialized in "shoulder/elbow", "hand surgery", "hip surgery", "knee surgery" and " foot surgery"; this department is approved to manage complex osteoarticular infections as well as bone and soft tissue tumours.
My current role in this department is mainly taking care of patients for hip and knee surgery and non-union outcomes. I also teach medical students and residents/fellows; I participate in national courses, in particular, the basic and superior hip courses organized by SOFCOT and the French society of hip and knee surgery (SFHG).
2. EHS: Do you also get involved in scientific matters and clinical research in Orthopaedics?
My interests have varied overtime over a career spanning from 1977 (hospital internship) to present. In the 80s, I became interested in trauma, fractures of the lower end of the femur for which I described a classification and developed a plate (1), fracture of the upper end of the femur for which I have developed a dynamic plate to get inserted percutaneously (2) and dislocations of the femoral head for which I have described a classification (3-5). At that time, I was one of the pioneers in France of arthroscopy of the hip for which we essentially described the operating techniques and the main highlighted pathologies (6); hip impingement was not yet well known. The treatment of non-union and bone loss is a subject of interest that has never left me; In 1986 I did a massive vascularized allograft of the femur, which is still in place without osteosynthesis (7); I was interested in 1992 in the action of osteoinductive proteins (8) and studied the treatment of open leg fractures and avascular necrosis of the femoral head (9, 10); I am currently evaluating the results of the concentrated marrow injection in aseptic non-union. I have described a minimally invasive arthroplasty technique, the results of which remain good in cases of hip dysplasia centred with a positive Wiberg angle (11).
From the 2000s I became interested in minimally invasive surgery; we compared the results of different types of approach (12-14); I described a minimal medial hip approach which allows reaching the tendon of the Iliac Psoas muscle as well as the lower portion of the femoral head to reduce for example a fracture of a third of the volume of the femoral head (15, 16). The femoral acetabular impingement was my subject of interest in the years 2010. We have with my team described a radiographic incidence which makes it possible to make the diagnosis and to evaluate the localisation and the volume of the deformations of the femoral neck (17, 18); we have described similar Perthes-disease deformities using an index and we have evaluated their frequency (19, 20); we have evaluated the results of minimal invasive anterolateral surgery (21).
I was also interested in the development and evaluation of a cross-linked polyethene cup stabilized by a thin metal-back shell (0.8 mm) made using 3D printer technology; the thinner the back metal, the more it is possible to use a large diameter head with sufficiently thick polyethene which reduces the risk of wear and reduces the risk of dislocation. I moved in the early 2000s to the technique of hip resurfacing with the proposal of an anterolateral technique guided by spindles (22-24); currently, I no longer apply resurfacing due to the risk of ions deseases and cervical fractures. I am currently moving towards the installation of short stems with main support on the calcar as “round-the-corner type”; we studied, in particular, the influence of the learning curve on the subsequent sinking of the rods. As the successor of Professor Paul Ficat, I have been interested throughout my career in necrosis of the femoral head (25); I had the honour of chairing the SOFCOT symposium on this topic in 2018.
3. EHS: What about your involvement in the Hip Toulouse Congress, and its partnership with the next International EHS 2020 Congress taking place in Lille, France?
With my team, we have organized since 1999 every three years an international congress on hip surgery named “Hip-Toulouse” which brings together between 700 and 1000 surgeons from many countries. The common thread of these scientific meetings consists of addressing new techniques as controversial debates, and also get taught by experts.
In 2020, this congress will merge as a partnership with EHS in Lille. Two symposia will be organized by “Hip-Toulouse” in collaboration with Professor Nicolas Reina. Firstly on short stems and then on acetabular reconstruction by cross, rings or custom-made prostheses.
We deeply hope that surgeons who were used attending the Hip-Toulouse meetings will travel up to Lille for this interesting and friendly Congress.
1. Chiron P. Fractures récentes de l’extrémité supérieure du fémur. Cahiers d’enseignement de la SOFCOT, Elsevier Masson. 1995;52:147-65.
2. Reina N, Geiss L, Pailhe R, Maubisson L, Laffosse JM, Chiron P. Traumax screw plate vs. Gamma nail. Blood loss in pertrochanteric fractures treated by minimally invasive osteosynthesis. Hip Int. 2014;24(2):200-5.
3. Chiron P, Lafontan V, Reina N. Fracture-dislocations of the femoral head. Orthop Traumatol Surg Res. 2013;99(1 Suppl):S53-66.
4. Tonetti J, Ruatti S, Lafontan V, Loubignac F, Chiron P, Sari-Ali H, et al. Is femoral head fracture-dislocation management improvable: A retrospective study in 110 cases. Orthop Traumatol Surg Res. 2010;96(6):623-31.
5. Chiron P. Les fractures luxations de la tête fémorale. Cahiers d’enseignement de la SOFCOT, Elsevier Masson. 2012;101:63-75.
6. Chiron P. Technique et indications de l’arthroscopie de hanche. Cahiers d’enseignement de la SOFCOT, Elsevier Masson. 2001;78:33_50.
7. Chiron P, Colombier JA, Tricoire JL, Puget J, Utheza G, Glock Y, et al. [A large vascularized allograft of the femoral diaphysis in man]. Int Orthop. 1990;14(3):269-72.
8. Chiron P. Proteines inductrices de l’os. Cahiers d’enseignement de la SOFCOT, Elsevier Masson. 2004;85:271-91.
9. Govender S, Csimma C, Genant HK, Valentin-Opran A, Amit Y, Arbel R, et al. Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Joint Surg Am. 2002;84(12):2123-34.
10. Chiron P. [Focus on allografts and bone substitutes. Round table discussion of the Study Group of Bone Tissue Substitutes 1997]. Rev Chir Orthop Reparatrice Appar Mot. 1998;84 Suppl 1:35-63.
11. Chiron P, Laffosse JM, Bonnevialle N. Shelf arthroplasty by minimal invasive surgery: technique and results of 76 cases. Hip Int. 2007;17 Suppl 5:S72-82.
12. Laffosse JM, Accadbled F, Molinier F, Chiron P, Hocine B, Puget J. Anterolateral mini-invasive versus posterior mini-invasive approach for primary total hip replacement. Comparison of exposure and implant positioning. Arch Orthop Trauma Surg. 2008;128(4):363-9.
13. Laffosse JM, Chiron P, Molinier F, Bensafi H, Puget J. Prospective and comparative study of the anterolateral mini-invasive approach versus minimally invasive posterior approach for primary total hip replacement. Early results. Int Orthop. 2007;31(5):597-603.
14. Laffosse JM, Chiron P, Accadbled F, Molinier F, Tricoire JL, Puget J. Learning curve for a modified Watson-Jones minimally invasive approach in primary total hip replacement: analysis of complications and early results versus the standard-incision posterior approach. Acta Orthop Belg. 2006;72(6):693-701.
15. Cavaignac E, Laumond G, Regis P, Murgier J, Reina N, Chiron P. Fixation of a fractured femoral head through a medial hip approach: an original approach to the femoral head. Hip Int. 2015;25(5):488-91.
16. Chiron P, Murgier J, Cavaignac E, Pailhe R, Reina N. Minimally invasive medial hip approach. Orthop Traumatol Surg Res. 2014;100(6):687-9.
17. Cavaignac E, Chiron P, Espie A, Reina N, Lepage B, Laffosse JM. Experimental study of an original radiographic view for diagnosis of cam-type anterior femoroacetabular impingement. Int Orthop. 2012;36(9):1783-8.
18. Espie A, Chaput B, Murgier J, Bayle-Iniguez X, Elia F, Chiron P. 45 degrees -45 degrees -30 degrees Frog-leg radiograph for diagnosing cam-type anterior femoroacetabular impingement: Reproducibility and thresholds. Orthop Traumatol Surg Res. 2014;100(8):843-8.
19. Murgier J, Espie A, Bayle-Iniguez X, Cavaignac E, Chiron P. Frequency of radiographic signs of slipped capital femoral epiphysiolysis sequelae in hip arthroplasty candidates for coxarthrosis. Orthop Traumatol Surg Res. 2013;99(7):791-7.
20. Murgier J, Chiron P, Cavaignac E, Espie A, Bayle-Iniguez X, Lepage B. The lateral view head-neck index (LVHNI): a diagnostic tool for the sequelae of slipped capital femoral epiphysis. Orthop Traumatol Surg Res. 2013;99(5):501-8.
21. Chiron P, Espie A, Reina N, Cavaignac E, Molinier F, Laffosse JM. Surgery for femoroacetabular impingement using a minimally invasive anterolateral approach: analysis of 118 cases at 2.2-year follow-up. Orthop Traumatol Surg Res. 2012;98(1):30-8.
22. Pailhe R, Reina N, Cavaignac E, Sharma A, Lafontan V, Laffosse JM, et al. Prospective study comparing functional outcomes and revision rates between hip resurfacing and total hip arthroplasty: preliminary results for 2 years. Orthop Rev (Pavia). 2013;5(3):e20.
23. Leclercq S, Lavigne M, Girard J, Chiron P, Vendittoli PA. Durom hip resurfacing system: retrospective study of 644 cases with an average follow-up of 34 months. Orthop Traumatol Surg Res. 2013;99(3):273-9.
24. Chiron P, Pailhe R, Reina N, Ancelin D, Sharma A, Maubisson L, et al. Radiological validation of a fluoroscopic guided technique for femoral implant positioning during hip resurfacing. Int Orthop. 2013;37(3):361-8.
25. Mazieres B, Marin F, Chiron P, Moulinier L, Amigues JM, Laroche M, et al. Influence of the volume of osteonecrosis on the outcome of core decompression of the femoral head. Ann Rheum Dis. 1997;56(12):747-50.