Hip and knee surgery



A SHORT BIOGRAPHY OF DIDIER PROST, MD

GRADUATIONS

  • Doctor of Medecine, PhD
  • Orthopedic Surgeon
  • Master of Orthopedic and Traumatologic Surgery
  • Master of Science in Micro-Surgery
  • Master of Science in Biomechanic for Orthopedic

SPECIALITIES

  • Arthrosis expertise
  • Knee and Hip Prosthesis surgery expertise
  • Ambulatory surgery expertise
  • Enhance Recovery After Surgery

HOSPITALS WHERE I PRACTICE

  • Private Hospital Clairval in Marseille (since 1992)
  • Monticelli Vélodrome Ambulatory Surgery Center in Marseille (since 2017)
  • Private Hospital Residence du Parc in Marseille (since 2007)
  • Clinique de l'Etang de l'Olivier in Istres (since 2009)

ACCREDITATION

Dr Didier PROST had his accreditation renewed on September 20, 2018 by the High Authority of Health (HAS) for a period of 4 years.

Accreditation certification : here.

Docteur Prost



MEDICAL SOCIETY

  • Member of the French Society of Orthopedic and Traumatologic Surgery
  • Member of the Society of Hip and Knee Surgery
  • Président of the non-profit organization
    of research on infection
    in orthopedic surgeries
  • Member of the French group of ERAS
    (Enhance Recovery After Surgery)
  • Member of the French Society of Ambulatory Surgery (SFCA)
  • Member of the French and the European Society of Surgical Oncology
  • Member of the French Society for Computer Assisted Surgery
  • Member of the International Society for Computer Assisted Orthopaedic Surgery

PERSONNAL EXPERIENCE IN PROSTHESIS SURGERY

HIP AND KNEE SURGICAL PROSTHESIS

Historically the goal of surgeons was to cure their patient, nonetheless the patient had to deal with some downside aspect of their case such as : large scars, suffering time, sickness, bad mood, inferiority complex...

At that time, one said : You are going to undergo your surgery. Physician healed an organ not a patient. Medicine was focused on the surgical technical gesture.

Moreover, before the nineties, when they operated, surgeons had to clearly see the injured organ in order to cure it. A well-known slogan was: “A large scar means a brilliant surgeon”.

In 1993, I performed a study on prosthesis scars : their average size was 10 inches length !






COMPUTER ASSISTED SURGERY TECHNIQUE

The computer-assisted surgery had made strong technical advances by the end of the nineties. In 1999, I had the opportunity in 1999 to be part of team of 6 French surgeons group to be trained and certified in this technique. Hence, between November 1999 and April 2001, I performed over 50 hip prosthesis utilizing this innovative technique, so-called CASPAR (Computer Assisted Surgical Planning And Robotics).

Unfortunately, this technology has not been rolled out over French healthcare system since it has not been approved for reimbursement for budget reasons. However, the CASPAR technique has been broadly deployed in Germany and in USA.



The initial CASPAR technique consisted in using a robot to drill the femur bone following the patient accurate scanner measurements. The obvious upside was the unparalleled 3D millimeter accuracy, that no human being was able to match. But the downside was the complexity of the process consisting in a 2 step-approach. A first operation had to place metal marks within the patient bones to get an accurate mapping through the scanner image. The second operation was to place the prosthesis with a larger scar.


MINI INVASIVE HIP SURGERY

From the early twenties, I did annual trips to USA for advanced surgery training and international workshops. I had the opportunity to meet Thomas Sculco, a well-recognized expert in orthopedic surgery. This surgeon set up a new surgery technique that was innovative not only on the technical side, but also on the philosophic side. Actually, this surgeon was convinced of the patient engagement factor in the success of a surgery.
Thomas Sculco trained me to place hip prosthesis with small incisions – 8 to 10 cm vs 20 -23 cm. I then followed up this advanced technique within the Chicago university and back in France, I trained French surgeons to use this technique.
The “minimal invasive surgery” was born.


This innovation has been a major forward step that has changed my surgery vision for ever. In fact, if the surgery goal is still to place a prosthesis, carefully preserving the soft tissues makes the operation philosophy much different : less bleeding and less pain make the recovery much faster.
From time to time, this mini-invasive technique has been enhanced reducing the bleedings and the surgery time, and above all the infection risks : the shorter the surgery is, the lesser the infection risks are.
But to use this technique, surgeons must have an appropriate training with regular practice since it requires more dexterity due to smaller incision. Today, this surgery time is less than one hour. In 2012, I decided to exclusively use this minimal invasive technique for hip and knee prosthesis.


NAVIGATION-ASSISTED TOTAL KNEE REPLACEMENT

Few times after, surgery navigation technique came up and brought a significant help to surgeons.
This technique is 5 times less pricey than the CASPAR technique. Thanks to my CASPAR experience, I succeeded to quickly and seamlessly use surgery navigation systems.

But it turns out that these systems help young surgeons more than the experienced one: they are adding extra steps within the surgery process that lengthen the surgery time.

Moreover, these robots dehumanized the surgery process and creates an extra mindset barrier between the surgeon and the patient.

Hence, the ROI for the patient is not clear and I decided not to pursue the use of navigation systems. But this innovative technique has been fruitful for my professional experience.



MINI INVASIVE KNEE SURGERY


In the same time, the minimal invasive techniques have been developed to the knee prosthesis as well.

The philosophy is the same: to preserve the soft tissues of the knee as much as possible. This minimal aggression of soft tissues significantly benefits to the patient: less pain, less bleedings, and faster recovery.

My initial training started in the USA and has been complemented in Paris in 2004.

This mini invasive surgery technique has been constantly enhanced by surgeons reaching the point where the infection risks are minimal due to a short surgery time.






ENHANCED RECOVERY AFTER SURGERY (ERAS)

In 2007, the danish surgeon Dr Kehlet pushed the enveloppe. Initially designed for the digestive surgery, he adapted the « fast track surgery » or « ERAS » to the orthopedic surgery. ERAS is a patient care pathway.

It has been successfully deployed in several countries for years. The ERAS process is very promising and should be extensively used in France since the Ministry of health changed the reimbursement method for arthroplasty of hip and knee.

The ERAS is not a specific surgical technique but a new medical process. This is a new organization within the whole medical team who becomes a patient-centric team. Therefore, the mindset of the patient is moving towards a more engaged mindset, the patient becomes pro-active of his recovery. This engagement clearly reduces the recovery time and increase the patient quality of life.

Medical studies clearly demonstrate that this ERAS process reduces post-surgical complications knowing that mini invasive techniques are a given to perform the ERAS care pathway.

ERAS has completely changed the way the medical team takes care of the patient pain. Thanks to this process, this pain factor has been stepped up as a critical factor and has been fixed thanks to a closer collaboration between surgeons and anesthetists. Reducing the pain level is a clear benefit for the patient but also for the healthcare system, saving an extra budget through a shorter hospital stay.

This is a major mentality change in France.

The patient is not considered as sick anymore, he is just an operated person.

To know more, please click here


AMBULATORY PROSTHESIS SURGERY

Now, we are reaching the ultimate goal of the ERAS process.

Since 2016, surgeons are able to proceed total hip or knee prosthesis (TKA or THA) within less a day. That means the patient entering the hospital in the morning, is able to get back home same day, late in the afternoon: just few hours within the hospital.

Multiple medical studies have clearly established that this process is not only safe for the patient but also creates significant benefits such as less post-surgery complications compared to traditional process. Ambulatory process is a standard process, and is performed on a daily basis in USA. It requires a specific organization within the hospital that could be compared to the lean management in the industry: a thorough analysis of each step of the medical process and organization enables an optimized care pathways, increasing the overall patient satisfaction.

The brand new Monticelli-Velodrome hospital, located in Marseille, that has started its operations in November 2016, is a center of excellence in the ambulatory process.

Today, two third of THA and half of TKA are performed under the ambulatory process.

To know more, you can click here