• Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound.

      Moran, Deirdre E; Moynagh, Michael R; Alzanki, Majedah; Chan, Victoria O; Eustace, Stephen J; Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. deirdreradiology@gmail.com (Skeletal radiology, 2012-09)
      Anaphylaxis during image-guided interventional procedures is a rare but potentially fatal event. Anaphylaxis to iodinated contrast is an established and well-recognized adverse effect. However, anaphylaxis to some of the other frequently administered medications given during interventional procedures, such as corticosteroids, is not common knowledge. During caudal epidural injection, iodinated contrast is used to confirm needle placement in the epidural space at the level of the sacral hiatus. A combination of corticosteroid, local anesthetic, and saline is subsequently injected. We describe a very rare case of anaphylaxis to a component of the steroid medication instilled in the caudal epidural space.
    • Cappagh National Orthopaedic Hospital annual report 2004.

      Cappagh National Orthopaedic Hospital (Cappagh National Orthopaedic Hospital, 2005)
    • Cappagh National Orthopaedic Hospital annual report , 2000

      Cappagh National Orthopaedic Hospital (Cappagh National Orthopaedic Hospital, 2001)
      Text not transferable.
    • 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.
    • 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.
    • Computational modelling of long bone fractures fixed with locking plates - How can the risk of implant failure be reduced?

      Nassiri, M; Macdonald, B; O'Byrne, J M; Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland. (Journal of orthopaedics, 2013-03)
      The Locking Compression Plate (LCP) is part of a new plate generation requiring an adapted surgical technique and new thinking about commonly used concepts of internal fixation using plates. Knowledge of the fixation stability provided by these new plates is very limited and clarification is still necessary to determine how the mechanical stability and the risk of implant failure can best be controlled.
    • Degenerative cervical spondylosis: natural history, pathogenesis, and current management strategies.

      Butler, Joseph S; Oner, F Cumhur; Poynton, Ashley R; O'Byrne, John M; Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. (Advances in orthopedics, 2012)
    • Diagnosing the doctors' departure: survey on sources of dissatisfaction among Irish junior doctors.

      Bruce-Brand, R; Broderick, J; Ong, J; O'Byrne, J; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11. robbrucebrand@gmail.com (Irish Medical Journal (IMJ), 2012-01)
      There has been a significant decline in the number of applications for non-consultant hospital doctor (NCHD) posts in Ireland over the last 18 months. We conducted an online, anonymous survey of Irish NCHDs to establish levels of satisfaction, sources of dissatisfaction and the major reasons for junior doctors seeking work abroad. 522 NCHDs took the survey, including 64 (12.3%) currently working outside of the Republic. 219 (45.8%) were slightly dissatisfied and 142 (29.7%) were extremely dissatisfied with practising medicine in Ireland. Major sources of dissatisfaction included the state of the health care system, staffing cover for leave and illness, the dearth of consultant posts and the need to move around Ireland. The most important reason for NCHDs wishing to leave was to seek better training and career opportunities abroad.
    • Diagnostic gait pattern of a patient with longstanding left femoral nerve palsy: a case report.

      Burke, Neil G; Walsh, Michael; O'Brien, Tim; Synnott, Keith; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. nei1burke@yahoo.co.uk (2010-12)
      The gait pattern of a 35-year-old man with longstanding, left femoral nerve palsy was assessed using 3-dimensional kinematic and kinetic analysis. Stability of his left knee in stance was achieved by manipulating the external moments of the limb so that the ground reaction force passes in front of the knee joint. This compensatory mechanism of locking the knee in extension is reliant on the posterior capsular structures. The patient was managed conservatively and continued to walk without aids.
    • 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).
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • Hand dominance in orthopaedic surgeons.

      Lui, Darren F; Baker, Joseph F; Nfila, Gala; Perera, Anthony; Stephens, Michael; Department of Trauma and Orthopaedics, Cappagh, National Orthopaedic Hospital, Finglas, Dublin, Ireland. darrenflui@gmail.com (Acta orthopaedica Belgica, 2012-08)
      Handedness is perhaps the most studied human asymmetry. Laterality is the preference shown for one side and it has been studied in many aspects of medicine. Studies have shown that some orthopaedic procedures had poorer outcomes and identified laterality as a contributing factor. We developed a questionnaire to assess laterality in orthopaedic surgery and compared this to an established scoring system. Sixty-two orthopaedic surgeons surveyed with the validated Waterloo Handedness Questionnaire (WHQ) were compared with the self developed Orthopaedic Handedness Questionnaire (OHQ). Fifty-eight were found to be right hand dominant (RHD) and 4 left hand dominant (LHD). In RHD surgeons, the average WHQ score was 44.9% and OHQ 15%. For LHD surgeons the WHQ score was 30.2% and OHQ 9.4%. This represents a significant amount of time using the non dominant hand but does not necessarily determine satisfactory or successful dexterity transferable to the operating room. Training may be required for the non dominant side.
    • 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)
    • Local anaesthetics and chondrotoxicty: What is the evidence?

      Baker, Joseph F; Mulhall, Kevin J; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. joseph.f.baker@gmail.com (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.
    • Locking plate fixation for proximal humerus fractures.

      Burke, Neil G; Kennedy, Jim; Green, Connor; Dodds, Michael K; Mullett, Hannan; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. neilburke@yahoo.co.uk (Orthopedics, 2012-02)
      Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.