• 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.
    • 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.
    • The use of postoperative suction drainage in total knee arthroplasty: a systematic review.

      Quinn, Mark; Bowe, Andrea; Galvin, Rose; Dawson, Peter; O'Byrne, John; Professorial Unit, National Orthopaedic Hospital, Cappagh, Finglas, Dublin 11, Republic of Ireland. (International orthopaedics, 2014-07-16)
      The purpose of this systematic review and meta-analysis of randomised controlled trials is to assess the effectiveness of no drainage when compared to drainage in total knee arthroplasty, in terms of recovery of knee flexion, reduction in swelling, length of hospital stay and haemoglobin levels following TKA.
    • Primary ankle arthrodesis for neglected open weber B ankle fracture dislocation.

      Thomason, Katherine; Ramesh, Ashwanth; McGoldrick, Niall; Cove, Richard; Walsh, James C; Stephens, Michael M; Foot and Ankle Orthopaedic Fellow, Cappagh National Orthopaedic Hospital, Dublin, Ireland. (The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 2014-07)
      Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described.
    • Unusual presentation of sacral fatigue fractures.

      Kilcoyne, Aoife; 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, 2014-06-01)
    • The forgotten foot - an assessment of foot and ankle radiograph pathology in final year medical students.

      Groarke, P J; Kelly, J C; Flanagan, E; Stephens, M M; Cappagh National Orthopaedics Hospital, Finglas, Dublin 11, Ireland. Electronic address: patrickgroarke007@gmail.com. (The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 2014-04-27)
      It has been shown that doctors in Emergency Departments (EDs) have inconsistent knowledge of musculoskeletal anatomy. This is most likely due to a deficiency in focused musculoskeletal modules at undergraduate level in medical school. The aims of this study were to evaluate the knowledge of final year medical students on foot anatomy and common foot and ankle pathology as seen on radiographs.
    • Radiation safety knowledge and practices among Irish orthopaedic trainees.

      Nugent, M; Carmody, O; Dudeney, S; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland, nugentmary@gmail.com. (Irish journal of medical science, 2014-04-23)
      Fluoroscopy is frequently used in orthopaedic surgery, particularly in a trauma setting. Exposure of patients and staff to ionising radiation has been studied extensively; however, little work has been done to evaluate current knowledge and practices among orthopaedic trainees.
    • Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty.

      Kelly, Enda G; Cashman, James P; Imran, Farrah H; Conroy, Ronán; O'Byrne, John; Department of Orthopaedic Surgery Cappagh National Orthopaedic Hospital Dublin, Ireland. (Surgical technology international, 2014-03)
      The routine use of drains in surgery has been dogmatically instituted in some disciplines. Orthopaedic surgery is one such sub-speciality. The use of postoperative closed suction drainage in total hip arthroplasty (THA) has become increasingly controversial with multiple randomised control trials performed to assess the benefit to outcome in THA. The hypothesis of this systematic review is that closed suction drainage does not infer a benefit and increase transfusion requirements of primary total hip arthroplasty patients. A systematic review and meta-analysis was conducted adhering to the PRISMA guidelines. A search of the available literature was performed on PubMed, Cochrane Central Registry of Controlled Trials, MEDLINE (OVID) and EMBASE using a combination of MeSH terms and Boolean operators. All data analysis was performed using the Cochrane Collaboration's Review Manager 5.1. Sixteen studies (n=2705) were included in the analysis. Post-operative closed suction drainage was found to increase total blood loss and blood transfusion requirements (p<0.05). Surgical site infection demonstrated no significant difference between the two groups (p=0.82). No significant difference in haematoma formation between groups (p=0.19) was elicited. The routine use of closed suction drainage systems post primary hip arthroplasty is not supported by this meta-analysis. However, the heterogeneity between studies does limit the accuracy of the meta-analysis.
    • 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, nigelphelan@rcsi.ie. (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.
    • Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures.

      Burke, Neil G; Cosgrave, Ciaran H; O'Neill, Barry James; Kelly, Eamonn P; Department of Orthopaedics, Cappagh National Orthopaedic Hospital, Dublin, Ireland. (BMJ case reports, 2014)
      Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.
    • Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty.

      Schneider, Marco M; Kendoff, Daniel; Oloughlin, Padhraig F; Hessling, Carola; Gehrke, Thorsten; Citak, Mustafa; Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany. (Technology and health care : official journal of the European Society for Engineering and Medicine, 2014)
      Autologous transfusion has become a cost-efficient and useful option in the treatment of patients with high blood loss following major orthopaedic surgery. However, the effectiveness of autologous transfusion in total joint replacement remains controversial.
    • 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. vikki_chan12@hotmail.com (Clinical radiology, 2013-10)
      To assess the incidence and clinical significance of medial joint line bone bruising following acute ankle inversion injury.
    • Effect of prehabilitation on the outcome of anterior cruciate ligament reconstruction.

      Shaarani, Shahril R; O'Hare, Christopher; Quinn, Alison; Moyna, Niall; Moran, Raymond; O'Byrne, John M; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Republic of Ireland. delphaex@gmail.com (The American journal of sports medicine, 2013-09)
      Prehabilitation is defined as preparing an individual to withstand a stressful event through enhancement of functional capacity.
    • A survey of upper and lower limb tourniquet use among Irish orthopaedic surgeons.

      Cunningham, L; McCarthy, T; O'Byrne, J; Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. larrycunningham@hotmail.com (Irish journal of medical science, 2013-09)
      Tourniquet use in orthopaedic surgery is common practice. However, the technique varies among Irish orthopaedic surgeons and there are no standard guidelines.
    • 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.
    • 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. vikki_chan12@hotmail.com (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.
    • 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. stevobrennan@hotmail.com (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.
    • "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.