• 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.
    • 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)
    • The mechanical effect of the existing cement mantle on the in-cement femoral revision.

      Keeling, Parnell; Lennon, Alexander B; Kenny, Patrick J; O'Reilly, Peter; Prendergast, Patrick J; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. parnellkeeling@gmail.com (Clinical biomechanics, 2012-08)
      Cement-in-cement revision hip arthroplasty is an increasingly popular technique to replace a loose femoral stem which retains much of the original cement mantle. However, some concern exists regarding the retention of the existing fatigued and aged cement in such cement-in-cement revisions. This study investigates whether leaving an existing fatigued and aged cement mantle degrades the mechanical performance of a cement-in-cement revision construct.
    • 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.
    • The meniscofemoral ligaments influence lateral meniscal motion at the human knee joint.

      Poynton, Ashley; Moran, Cathal J; Moran, Ray; O'Brien, Moira; Cappagh National Orthopaedic Hospital, Dublin, Ireland. (2011-03)
      The purpose of this study was to investigate the effect of the meniscofemoral ligaments on lateral meniscal motion during flexion and extension of the human knee joint.
    • 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.
    • Multimodality treatment of a complex series of parallel pathologies in a 16-year-old male that ultimately leads to bilateral hip arthroplasty surgery: A case report.

      Cullen, Emmet; Quinlan, John; Fogarty, Esmond; Keogh, Peter; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. (International journal of surgery case reports, 2012)
      Femoral head osteonecrosis is associated with significant sequelae for the patient in the long-term. A combination of factors are thought to contribute to the pathophysiology behind this debilitating disease process.
    • Musculoskeletal oncology training during residency.

      Burke, Neil G; Moran, Cathal J; Hurson, Brian; Dudeney, Sean; O'Toole, Gary C; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. nei1burke@yahoo.co.uk (Journal of orthopaedic surgery, 2011-12)
      To evaluate the efficacy of a musculoskeletal oncology training module during residency.
    • 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. 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.
    • Nonoperative modalities to treat symptomatic cervical spondylosis.

      Hirpara, Kieran Michael; Butler, Joseph S; Dolan, Roisin T; O'Byrne, John M; Poynton, Ashley R; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. (2012)
      Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately controlled by nonoperative means. A review of the literature supporting various modalities of conservative management is presented, and it is concluded that although effective, nonoperative treatment is labour intensive, requiring regular review and careful selection of medications and physical therapy on a case by case basis.
    • 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.