• Comparison of acetabular reamings during hip resurfacing versus uncemented total hip arthroplasty.

      Brennan, S A; Harty, J A; Gormley, C; O'Rourke, S K; Department of Orthopaedics, Cappagh Hospital, Finglas, Dublin, Ireland. stevobrennan@hotmail.com (2009-04)
      PURPOSE: To compare the quantity of bone removed from the acetabulum during resurfacing hip arthroplasty versus uncemented total hip arthroplasty (THA). METHODS: 62 consecutive patients with osteoarthritis of the hip were prospectively studied. 24 men and 7 women aged 40 to 86 (mean, 59) years underwent Birmingham hip resurfacing. 13 men and 18 women aged 34 to 88 (mean, 61) years underwent uncemented THA using the trident acetabular cup. Obese elderly women at risk of femoral neck fracture and patients with large subchondral pseudocysts or a history of avascular necrosis of the femoral head were assigned to uncemented THA. Acetabular reamings were collected; marginal osteophytes were not included. The reamings were dehydrated, defatted, and weighed. RESULTS: The mean weight of acetabular reamings was not significantly different between patients undergoing hip resurfacing and uncemented THA (p=0.57). CONCLUSION: In hip resurfacing, the use of an appropriately small femoral component avoids oversizing the acetabular component and removal of excessive bone stock.
    • Dislocation of primary total hip arthroplasty and the risk of redislocation.

      Brennan, Stephen A; Khan, Fahim; Kiernan, Christine; Queally, Joseph M; McQuillan, Janette; Gormley, Isobel C; O'Byrne, John M; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. stevobrennan@hotmail.com (Hip international : the journal of clinical and experimental research on hip pathology and therapy, 2012-09)
      6554 primary total hip arthroplasties were reviewed. Risk factors for dislocation were analysed to assess which were important in terms of predicting recurrent instability. The patients risk of having a second dislocation was independently associated with the surgical approach adopted (p = 0.03) and the time to first dislocation from the primary hip replacement (p = 0.002). Early dislocators whose surgery was performed through an anterolateral approach had less recurrence than late dislocators through a posterior or transtrochanteric approach. None of the other risk factors including head size (p = 0.59), modularity (p = 0.54), mechanism of dislocation (p = 0.23), leg length discrepancy (p = 0.69) and acetabular inclination (p = 0.31) were influential. The use of an abduction brace was not useful in preventing a further dislocation with 69.2% of those braced re-dislocating compared to 68.5% who were not braced (p = 0.96).
    • 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.
    • 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 groarke@yahoo.co.uk (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.
    • Total joint arthroplasty in nonagenarians--a retrospective review of complications and resource use.

      Baker, Joseph F; Stoyanov, Veselin; Shafqat, Aseer; Lui, Darren F; Mulhall, Kevin J; Cappagh National Orthopaedic Hospital, Dublin, Ireland. joseph.f.baker@gmail.com (Acta orthopaedica Belgica, 2012-12)
      Increased age brings with it the potential for increased surgical risk. Assessment of specific age cohorts is necessary to plan future service provision and this is the case in hip and knee arthroplasty as the demand for these procedures is anticipated to increase. We retrospectively reviewed the outcomes, including complications, length of stay and blood transfusion rate, in a cohort of 35 nonagenarians undergoing primary or revision total hip and knee arthroplasty. All patients were pre-assessed by anaesthetists before being deemed suitable to undergo surgery in the unit. The mean length of hospital stay was 13.7 +/- 10 days (range 2-56). Thirty-one percent of patients required a blood transfusion. Patients who underwent primary total hip arthroplasty reported improved joint specific functional scores. In this appropriately selected group of nonagenarians, we found no evidence to suggest surgery be withheld on the basis of age alone. However, patients with multiple medical comorbidities warrant appropriate assessment and surgical intervention in an institution with appropriate support. Future planning needs to take into account the predicted increase in demand for arthroplasty surgery in this age group.