• 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.
    • Postoperative infection in the foot and ankle.

      Chan, Victoria O; Morrison, William B; Kavanagh, Eoin C; Department of Radiology, Cappagh National Orthopaedic Hospital, Dublin, Ireland. vikki_chan12@hotmail.com (Seminars in musculoskeletal radiology, 2012-07)
      Our discussion highlights the commonly performed surgical procedures in the foot and ankle and reviews the various imaging modalities available for the detection of infection with graphic examples to better enable radiologists to approach the radiological evaluation of postoperative infection in the foot and ankle. Discrimination between infectious and noninfectious inflammation remains a diagnostic challenge usually needing a combination of clinical assessment, laboratory investigations, and imaging studies to increase diagnostic accuracy.
    • 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.
    • 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.
    • A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements.

      Burke, Neil G; Green, Connor; McHugh, Gavin; McGolderick, Niall; Kilcoyne, Carol; Kenny, Patrick; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. nei1burke@yahoo.co.uk (Journal of tissue viability, 2012-08)
      It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing.
    • 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.
    • 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.
    • 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.
    • Simian foot at skeletal maturity: long-term case report followup.

      Groarke, Patrick J; Thomason, Katharine; Stephens, Michael M; Cappagh National Orthopaedic Hospital, Foot and Ankle, Finglas, Dublin, 22, Ireland. patrickgroarke007@gmail.com (Foot & ankle international. / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society, 2012-08)
    • "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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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 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.