Research by staff affiliated to Cappagh National Orthopaedic Hospital

Recent Submissions

  • Prognostic Importance of Pathological Fractures in Osteosarcomas.

    Sheridan, G A; Mellon, L; Thompson, E M; O'Kane, G M; O'Toole, G C (2020-12-16)
    Aims To investigate whether pathological fractures impact on osteosarcoma patient prognosis in Ireland. Methods This was a retrospective study over 22 years in a National Orthopaedic Oncology Centre. There were 117 nonfracture cases and 15 fracture cases. Outcome measures included 5 and 10 year event-free (EFS) and overall survival (OS). Kaplan-Meier curves assessed length of survival and time to death. Results Pathological fracture has no significant effect on 10 year EFS or 10 year OS. 3 factors strongly associate with 10 year OS rates: American Joint Committee on Cancer (AJCC) classification (p<0.001), Metastases site (p<0.001) and Distant recurrence (p<0.001). Fractures had poorer post-chemotherapeutic necrosis rates (p=0.005). Conclusion Pathological fractures have no significant effect on survival rates or length of survival in an Irish population. The effect of pathological fractures on necrosis rates must be explored in future research.
  • The Role of a Seven-Day Physiotherapy Service in Reducing Length of Stay and Improving Cost-Effectiveness in Arthroplasty Surgery.

    Cashman, James; Staunton, Peter; Grant-Freemantle, Marc; Pomeroy, Eoghan (2023-01-18)
    Background Length of hospital stay post hip and knee arthroplasty is influenced by several factors, including gender, home circumstances and underlying diagnosis. Due to increasing demand for hip and knee arthroplasty, elective units, operating within already stressed healthcare systems, must identify methods of increasing efficiency and capacity. We sought to establish whether the lack of a seven-day inpatient physiotherapy service resulted in an increased hospital length of stay post primary hip and knee arthroplasty. Methods One hundred consecutive joint replacements (50 total hip replacements and 50 total knee replacements (TKRs)), performed in our institution from January to February 2020, were assessed. The length of stay for the cohort was analysed, and delays to discharge were identified. T-test was used to analyse the difference in length of stay based on the day of the week the surgery was performed. Results The mean length of stay for all primary hip and knee arthroplasties was 3.42 (standard deviation (SD): 1.62) days. Hip and knee arthroplasties performed on a Thursday or Friday had a significantly higher average length of stay than those performed on Monday, Tuesday or Wednesday (3.89 versus 3.02, p=0.006). We calculated that operating a six-day versus seven-day physiotherapy service in our unit cost 318 bed days per year equating to €986,535. Conclusion Length of stay post total hip and knee arthroplasty in our unit is significantly affected by the day of the week that surgery is performed. Elective orthopaedic units should consider all means of maximising efficiency and lowering costs given the future challenges in service provision.
  • Current concepts and outcomes in cemented femoral stem design and cementation techniques: the argument for a new classification system.

    Cassar-Gheiti, Adrian J; McColgan, Rosie; Kelly, Martin; Cassar-Gheiti, Theresa M; Kenny, Paddy; Murphy, Colin G (2020-04-02)
    Cemented implant fixation design principles have evolved since the 1950s, and various femoral stem designs are currently in use to provide a stable construct between the implant-cement and cement-bone interfaces. Cemented stems have classically been classified into two broad categories: taper slip or force closed, and composite beams or shaped closed designs. While these simplifications are acceptable general categories, there are other important surgical details that need to be taken into consideration such as different broaching techniques, cementing techniques and mantle thickness. With the evolution of cemented implants, the introduction of newer implants which have hybrid properties, and the use of different broaching techniques, the classification of a very heterogenous group of implants into simple binary categories becomes increasingly difficult. A more comprehensive classification system would aid in comparison of results and better understanding of the implants' biomechanics. We review these differing stem designs, their respective cementing techniques and geometries. We then propose a simple four-part classification system and summarize the long-term outcomes and international registry data for each respective type of cemented prosthesis. Cite this article: EFORT Open Rev 2020;5:241-252. DOI: 10.1302/2058-5241.5.190034.
  • Expectations of general practitioners for patients undergoing elective total knee arthroplasty

    Nugent, M; Carmody, O; Kenny, PJ (Irish Medical Journal, 2015-09)
    Most patients undergoing total knee arthroplasty (TKA) in Ireland are referred to orthopaedic services by their general practitioners (GPs). We aimed to evaluate Irish GPs’ expectations for their patients’ perioperative experience and post-operative return to function. A questionnaire was mailed to 350 GPs in all provinces. This included questions relating to GPs’ expectations for their patients and their knowledge and sources of information on TKA. 111 completed questionnaires were returned (response rate 31.7%). Overall expectations for functional and psychological outcomes were high, especially regarding pain relief (108 (97.3%)) expected relief from most or all pre-operative pain), mobility (108 (97.3%)) expected patients to walk medium or long distances) and psychological wellbeing (95 (85.5%) considered this somewhat or very important). Only 22 (20.2%) reported receiving any relevant information or training within the previous year. Overall expectations for functional outcomes were high, however greater communication between surgeons and GPs may improve GP information.
  • Cappagh National Orthopaedic Hospital annual report , 2000

    Cappagh National Orthopaedic Hospital (Cappagh National Orthopaedic Hospital, 2001)
    Text not transferable.
  • Cappagh National Orthopaedic Hospital annual report 2004.

    Cappagh National Orthopaedic Hospital (Cappagh National Orthopaedic Hospital, 2005)
  • Post operative complications in a dedicated elective orthopaedic hospital: transfers requiring specialist critical care support

    Dawson, P; Daly, A; Lui, D; Butler, JS; Cashman, J (Irish Medical Journal, 2015-05)
    We aim to report our experience with out of hospital transfers for postoperative complications in a stand-alone elective orthopaedic hospital. We aim to describe the cohort of patients transferred, the rate of transfer and assess the risk factors for transfer. Patients were identified who were transferred out of the hospital to another acute hospital for management of non-routine medical problems. Patient data was collected relating to age, BMI, ASA, type of surgery, nature of the complication, timing and the outcome of transfer. In 2012, 2,853 inpatient surgical procedures were carried out, 51 patients (1.8%) developed a postoperative complication that required out of hospital transfer. Mean age of patients transferred was 67 (12-86) years, mean age of the overall case mix 58 years (0-96) (p=0.01). 37.7% of the overall case mix of surgeries was made up of primary hip and knee arthroplasty procedures, these patients made up 63.7% of patients transferred out (p=0.001). Mean BMI recorded was 31.7 (22-48) compared to the mean BMI of the total arthroplasty case mix of 28.8 (20-44) (p=0.02). 59% of all patients at our institution were ASA category II or III. 76% of patients transferred were ASA category II or III (p=0.005). We can conclude that patients requiring transfer are typically older. Arthroplasty patients are more likely to require transfer than patients undergoing other orthopaedic procedures. Among the arthroplasty cohort transferred patients will typically have a higher BMI than average. Patients with ASA category II or III make up nearly three quarters of those patients transferred. The mean age of patients transferred is typically older by 9 years.
  • Local anaesthetics and chondrotoxicty: What is the evidence?

    Baker, Joseph F; Mulhall, Kevin J; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. (Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2012-11)
    Recent reports have suggested that local anaesthetic agents have a toxic effect on articular chondrocytes. This is despite the widespread intra-articular use of local anaesthetic agents following arthroscopic procedures for a number of years.
  • "Superior cleft sign" as a marker of rectus abdominus/adductor longus tear in patients with suspected sportsman's hernia.

    Murphy, Grainne; Foran, Paul; Murphy, Darra; Tobin, Oliver; Moynagh, Michael; Eustace, Stephen; Radiology Department, Cappagh National Orthopaedic Hospital, Cappagh Road, Finglas, Dublin 11, Ireland. (Skeletal radiology, 2013-06)
    We describe a new imaging sign, the "superior cleft sign", identified at both symphysography and MRI, which should be used as a marker of rectus abdominis/adductor longus attachment tearing.
  • Lumbar Morel-Lavallée effusion.

    Moran, Deirdre E; Napier, Nicholas A; Kavanagh, Eoin C; Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. (The spine journal : official journal of the North American Spine Society, 2012-12)
  • Prevalence and clinical significance of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease: observations at MR imaging.

    Chan, V O; Moran, D E; Mwangi, I; Eustace, S J; Department of Radiology, Cappagh National Orthopaedic Hospital, Dublin, Ireland. (Skeletal radiology, 2013-08)
    To determine the prevalence of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease in patients with anterior knee pain and to correlate it with patient demographics, patellar shape, and patellofemoral alignment.
  • MicroRNA function and dysregulation in bone tumors: the evidence to date.

    Nugent, Mary; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland. (Cancer management and research, 2014)
    Micro ribonucleic acids (miRNAs) are small non-coding RNA segments that have a role in the regulation of normal cellular development and proliferation including normal osteogenesis. They exert their effects through inhibition of specific target genes at the post-transcriptional level. Many miRNAs have altered expression levels in cancer (either increased or decreased depending on the specific miRNA). Altered miRNA expression profiles have been identified in several malignancies including primary bone tumors such as osteosarcoma and Ewing's sarcoma. It is thought that they may function as tumor suppressor genes or oncogenes and hence when dysregulated contribute to the initiation and progression of malignancy. miRNAs are also thought to have a role in the development of bone metastases in other malignancies. In addition, evidence increasingly suggests that miRNAs may play a part in determining the response to chemotherapy in the treatment of osteosarcoma. These molecules are readily detectable in tissues, both fresh and formalin fixed paraffin embedded and, more recently, in blood. Although there are fewer published studies regarding circulating miRNA profiles, they appear to reflect changes in tissue expression. Thus miRNAs may serve as potential indicators of disease presence but more importantly, may have a role in disease characterization or as potential therapeutic targets. This review gives a brief overview of miRNA biochemistry and explores the evidence to date implicating these small molecules in the pathogenesis of bone tumors.
  • Images in clinical medicine. Hallux varus.

    Ryan, Katie; Moroney, Paul; Cappagh National Orthopaedic Hospital, Dublin, Ireland. (The New England journal of medicine, 2013-11-28)
  • Medial joint line bone bruising at MRI complicating acute ankle inversion injury: what is its clinical significance?

    Chan, VO; Moran, DE; Shine, S; Eustace, SJ; Department of Radiology, Cappagh National Orthopaedic Hospital, Dublin, Ireland. (Clinical radiology, 2013-10)
    To assess the incidence and clinical significance of medial joint line bone bruising following acute ankle inversion injury.
  • Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials.

    Abdulkarim, Ali; Ellanti, Prasad; Motterlini, Nicola; Fahey, Tom; O'Byrne, John M; Department of Orthopaedics, Cappagh National Orthopaedic Hospital, Finglas, Dublin; Royal College of Surgeons, Dublin, Ireland. (Orthopedic reviews, 2013-02-22)
    The optimal method of fixation for primary total hip replacements (THR), particularly fixation with or without the use of cement is still controversial. In a systematic review and metaanalysis of all randomized controlled trials comparing cemented versus uncemented THRS available in the published literature, we found that there is no significant difference between cemented and uncemented THRs in terms of implant survival as measured by the revision rate. Better short-term clinical outcome, particularly an improved pain score can be obtained with cemented fixation. However, the results are unclear for the long-term clinical and functional outcome between the two groups. No difference was evident in the mortality and the post operative complication rate. On the other hand, the radiographic findings were variable and do not seem to correlate with clinical findings as differences in the surgical technique and prosthesis design might be associated with the incidence of osteolysis. We concluded in our review that cemented THR is similar if not superior to uncemented THR, and provides better short term clinical outcomes. Further research, improved methodology and longer follow up are necessary to better define specific subgroups of patients in whom the relative benefits of cemented and uncemented implant fixation can be clearly demonstrated.
  • Quality of life in individuals with chronic foot conditions: a cross sectional observational study.

    Groarke, Patrick; Galvin, Rose; Kelly, John; Stephens, Michael M; National Orthopaedic Hospital, Cappagh, Finglas, Dublin 9, Ireland. patrick (Foot, 2012-06)
    Chronic foot conditions have been reported to be a significant cause of impairment and disability to individuals affected. However, studies to date have particularly focussed on patient satisfaction with outcomes following surgery.
  • The effect of the metal-on-metal hip controversy on internet search activity.

    Phelan, Nigel; Kelly, John C; Kenny, Patrick; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland, (European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2014-01-04)
    The recall of the articular surface replacement (ASR) hip prosthesis in 2010 represents one of the most controversial areas in orthopaedic surgery in recent years. The aim of this study was to compare the impact of the metal-on-metal hip controversy on Internet search activity in four different regions and determine whether the number of related news reports affected Internet search activity. The Google Trends, Keywords and News applications were used to record the number of news articles and Internet search activity for the terms "hip recall", "metal-on-metal hip" and "ASR hip" from October 2009 to October 2012 in the USA, the UK, Australia and Ireland. There was a large increase in search activity following the official recall in August 2010 in all countries. There was significantly greater search activity after the recall in Ireland compared with the UK for the search term "hip recall" (P = 0.004). For the term "metal-on-metal hip", the UK had significantly more search activity (P = 0.0009). There was a positive correlation between the number of news stories in UK and Ireland with Internet search activity but not in the USA or Australia. Differences between countries affected by the same recall highlight the complex effects of the media on public awareness. The data demonstrates a window of opportunity prior to the official recall for the development of an awareness campaign to provide patients with accurate information.
  • The natural history and clinical syndromes of degenerative cervical spondylosis.

    Kelly, John C; Groarke, Patrick J; Butler, Joseph S; Poynton, Ashley R; O'Byrne, John M; Department of Trauma and Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, The Royal College of Surgeons in Ireland, Finglas, Dublin 11, Ireland. (Advances in orthopedics, 2012)
    Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal can result in spinal cord compression, ultimately resulting in cervical spondylosis myelopathy. This review article examines the current literature in relation to the cervical spondylosis and describes the three clinical syndromes of axial neck pain, cervical radiculopathy and cervical myelopathy.
  • Neck narrowing in resurfacing hip arthroplasty: a vascular insult?

    Brennan, S A; Khan, F; McQuillan, J; O'Neill, C J; Kenny, P; O'Rourke, S K; O'Byrne, J M; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. (Irish journal of medical science, 2013-06)
    Recent reports show increased failure rates in hip resurfacings that display >10 % neck narrowing. The etiology of neck narrowing remains unknown.
  • The role of osteoblasts in peri-prosthetic osteolysis.

    O'Neill, S C; Queally, J M; Devitt, B M; Doran, P P; O'Byrne, J M; Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland. (The bone & joint journal, 2013-08)
    Peri-prosthetic osteolysis and subsequent aseptic loosening is the most common reason for revising total hip replacements. Wear particles originating from the prosthetic components interact with multiple cell types in the peri-prosthetic region resulting in an inflammatory process that ultimately leads to peri-prosthetic bone loss. These cells include macrophages, osteoclasts, osteoblasts and fibroblasts. The majority of research in peri-prosthetic osteolysis has concentrated on the role played by osteoclasts and macrophages. The purpose of this review is to assess the role of the osteoblast in peri-prosthetic osteolysis. In peri-prosthetic osteolysis, wear particles may affect osteoblasts and contribute to the osteolytic process by two mechanisms. First, particles and metallic ions have been shown to inhibit the osteoblast in terms of its ability to secrete mineralised bone matrix, by reducing calcium deposition, alkaline phosphatase activity and its ability to proliferate. Secondly, particles and metallic ions have been shown to stimulate osteoblasts to produce pro inflammatory mediators in vitro. In vivo, these mediators have the potential to attract pro-inflammatory cells to the peri-prosthetic area and stimulate osteoclasts to absorb bone. Further research is needed to fully define the role of the osteoblast in peri-prosthetic osteolysis and to explore its potential role as a therapeutic target in this condition.

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