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Dozens of children may have undergone unnecessary hip surgeries, says new report

Dozens of children may have undergone unnecessary hip surgeries, says new report

Dublin Live23-05-2025
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Dozens of children who underwent hip surgeries at Cappagh and Temple Street did not meet an international expert's full criteria for hip surgery, a damning new report has found.
In nearly 80% of cases at Cappagh Orthopaedic Hospital and 60% of cases at Temple Street, lower decision-making thresholds were used to decide whether surgeries should be conducted. It is likely that hundreds of children may have been operated on at a lower threshold, as it is understood that it is likely this standard was applied going back "many years".
CHI and National Orthopaedic Hospital at Cappagh (NOHC) commissioned an audit after a whistleblower raised concerns about the thresholds used to decide whether to perform surgery for children with Developmental Hip Dysplasia (DHD) at Temple Street and Cappagh. This surgery relates to the failure of the full formation of the hip socket in children. It can be identified through screening and is followed up with other investigations such as X-rays and ultrasound.
CHI commissioned UK-based Consultant Paediatric Orthopaedic Surgeon Mr Simon Thomas to review a random sample of surgery cases carried out on children aged between one and seven between 2021 and 2023 across Temple Street, Crumlin, and Cappagh hospitals. In total, Mr Thomas reviewed 147 random and anonymous cases across the three hospitals.
The report found that there were significantly different thresholds for recommending pelvic osteotomy procedures between Crumlin, Temple Street and The National Orthopaedic Hospital in Cappagh. At CHI Crumlin, the threshold for performing hip surgeries on children was fully in line with the criteria used by the international expert who wrote the report. However, Mr Thomas raised concerns about the threshold for surgery in many cases in Temple Street and Cappagh Hospital.
What was called "novel picking" was used. In this context, an existing but less invasive procedure was completed, but questions were raised about the threshold for surgery. Mr Thomas sampled 51 cases out of a total of 114 surgeries done at Cappagh. Of 70 pelvic osteotomies, just 15 met the audit criteria (21%).
At Temple Street, 49 cases were audited out of 127 that took place in the hospital between 2021 and 2023. Out of 85 pelvic osteotomies, 34 met the audit criteria (40%). At Crumlin, 47 cases of 101 were audited. Of 63 pelvic osteotomies, 62 met the audit criteria
This means that 79% of surgeries at Cappagh and 60% of surgeries at Temple Street did not reach the criteria required for surgery set out by Mr Thomas. The audit also identified one case from the review sample where a child experienced complications due to the surgical approach recommended to them.
Mr Thomas said in many of the Crumlin and Cappagh cases sampled, there was no record of closed or open hip reduction after delayed diagnosis, no record of either hip ever having been dislocated and "often no history of treatment soon after birth by splint or brace for hip instability". All 497 cases that have undergone pelvic osteotomy at Cappagh and Temple Street between 2021 and 2023 now require ongoing follow-up to skeletal maturity.
Around 1,800 children and young adults who have had this surgery at CHI at Temple Street and Cappagh since 2010 will now be reviewed. These families will be recalled and should undergo an independent clinical review and radiological assessment, the report stated.
This group of patients will be contacted directly to explain what this means and the next steps for them. An external independent panel of surgeons with expertise in DDH surgery is currently being established to review all patients who underwent surgery for DDH in CHI at Temple Street from 2010 and Cappagh from 2021 to establish whether the criteria for surgery aligned with acceptable parameters as determined by the expert panel. Families will be involved throughout this process.
Bernard Gloster, CEO of the HSE, said that the variance in surgical practice between Cappagh and Temple Street was concerning. He said: "The proportion of pelvic osteotomies taking place at CHI at Temple Street and NOHC, despite not reaching the international criteria used in the audit, was so high that the audit report says further inquiry is mandated.
"Focus on follow-up and putting in place a mechanism to ensure this kind of variation can't recur is central to our next steps, and we will be working with everyone to ensure that this can't happen again." CHI and Cappagh Hospital have established a dedicated contact number which will be supported by clinical staff and will support patients and families who are seeking further information about their care and the next steps.
The phone line is open Monday to Friday 8am to 8pm, and Saturday and Sunday 9am to 5pm. The number is Freephone 1800 807 050, or 00 353 1 240 8706 from outside Ireland. Health Minister Jennifer Carroll MacNeill said she has 'moved immediately to strengthen governance and oversight structures at CHI and NOHC'.
She said: "In responding to this Report, I am thinking first and foremost of the impact a surgery has on a child. I am also deeply aware of the worry that parents will face today and this is something that is sitting with me all the time.
"My immediate priority is to ensure that there is clinical follow-up and care for patients who have undergone pelvic osteotomy surgery. This follow-up will be in accordance with best practice and the recommendations of the Report."
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Things have come on such a huge distance in a very short time, but it's coming from such a low base in terms of service accessibility that there is still a way to go.' [ Eating disorders: 'I wouldn't speak to my worst enemy the way I talked to myself' Opens in new window ] In recent years, the Government has taken steps to improve eating-disorder services. Currently, 14 of the 16 specialist eating disorder teams recommended in its internal plans are funded. Minister of State for Mental Health Mary Butler says no patients have been treated abroad this year so far for specialist eating-disorder care. 'I'm very proud of the progress we are making in establishing a full suite of services to support people with eating disorders, from early intervention in the community to the development of specialist inpatient beds for acute care,' she says. However, things are far from perfect, those working in the sector say. Figures from the HSE show that one-third of funded posts at eating disorder regional specialists teams are currently unfilled. In the adult eating disorder team in the Sligo, Leitrim, South Donegal health area, there are more vacancies than people in post: 3.2 whole-time equivalent staff are in place, with seven unfilled posts in the area. Furthermore, there are only three adult specialist eating disorder beds in the country, all of which are in St Vincent's hospital, Dublin. The rules for these beds, which are for those who are acutely unwell, require patients to be within that hospital's catchment area to be treated there. As a result, people with eating disorders outside that area who go into public hospitals for treatment are typically referred to a general psychiatric unit. Often they are unable to access specialised care in such settings. However, The Irish Times understands a plan has been devised by the HSE to increase the number of public eating-disorder beds nationally. Minister of State for Mental Health Mary Butler says no patients have been treated abroad this year so far for specialist eating-disorder care. Photograph: Brian Lawless/PA Wire At least 20 new specialist beds will be established in the coming years, under proposals submitted by the HSE for Ms Butler's approval. The beds will be spread between Dublin and the rest of the country, but all of them will have a national catchment area. For some people, recovery feels impossible. Aoife, which is not her real name, developed eating disorder behaviours when she was 12, after she sought to lose weight for her Confirmation. 'My family weren't very nice about my body. But also society. You'd be in drama class and I was the biggest so I would have to try on the costume and if it didn't fit me then nobody would get it. Then there were things like the Special K diet, or Kate Moss's saying about skinny being better,' she says. The 32-year-old Cork woman says she was diagnosed with anorexia at the age of 15, and went into hospital when she was 16, which she describes as 'the worst point in my life ever'. 'I couldn't control anything. I had a tube in my nose, I wasn't allowed to walk anywhere. I basically just lay in bed. I soiled myself because it would expend too much energy to go to the bathroom. It was only about weight restoration, not about treating the eating disorder,' she says. She struggled through college but was determined to continue her studies. I've been told I'll never recover. I have chronic anorexia. So you ask yourself, what's the point in trying? — 'Aoife' After graduating as a teacher, she realised she needed to get better before she could work full-time. In 2016, she returned to inpatient care. She improved somewhat, she says, but was not in recovery. She was admitted again two years ago, but had to leave early due to panic attacks. For her, she says, a history of trauma is playing a role in her current condition: her sister died when she was very young. 'I overate when she died; that was soothing myself. My life felt out of control, I didn't know who would die next. Food was something I could control,' she says. But it is 20 years since the onset of those challenges. These days, she feels quite hopeless about her current trajectory. 'I've been told I'll never recover. I have chronic anorexia. So you ask yourself, what's the point in trying? Normal eating is no longer normal for me. This has become my normal and it's very hard to see outside of it,' she says. [ Eating disorders in later life: Some of my peers have had teenage weight levels for decades Opens in new window ] 'It's pointless to be here every day. I keep wondering, how did things come to this? I'd love for someone to tell me what to do because I just don't know where to go or what to do. I look inward wondering what I could do differently. What did I do to deserve this?' Trying to find somewhere to go is something many patients experience. Alicia Woods, clinical nurse specialist at Lois Bridges, says the centre is a private facility, but they receive 'phone calls everyday of the week from people who don't have private health insurance'. 'We treat a range of eating disorders. And in terms of age, we've treated from 18 up to people in their early 70s,' she says. 'The majority of older people with eating disorders have had it their whole life but they just haven't had the information, education or support to seek help. Some people do develop it later in life.' Though Woods says the reasons why individuals develop eating disorders are complex and nuanced, she believes social media is playing a role. 'Body positivity was such a thing, but now we've gone back almost 20 years. The videos on social media, encouraging people to obsessively run 5K a day, or the 'what I eat in a day' videos [and the food quantity] is not enough to feed a toddler,' she says. She is also concerned about the potential impact the widespread availability of weight loss jabs like Ozempic might have on vulnerable individuals. 'We know that people can put in fake weights and get these prescriptions. If someone already has a low [body mass index] ... the potential of that is frightening,' she adds. But even when people can access treatment, often recovery is not linear, according to 38-year-old Edel Higgins. She was diagnosed with an eating disorder when she was around 25. She didn't know much about such disorders at the time, but says she had 'always tried to change my physical appearance'. [ Families: the untapped superpower in eating disorder recovery Opens in new window ] It took four inpatient stays before she reached a point where she sees herself as being in recovery. She says: 'It doesn't just take one go. People often feel guilty when they have to go back. But it's such a complex illness.' The Tallaght woman is four years in 'proper recovery', but she says for her that doesn't mean the eating disorder is 'completely gone', but just now she has the 'resilience' to acknowledge and challenge those urges when they arise. She writes poetry to help her cope. She looks at inspirational quotes hung up on her wall. 'Sometimes I wish I could wake up, go about the day, not having all of these overwhelming feelings – the eating disorder and mental health [difficulties]. But it doesn't work that way. It can be frustrating. But it's about findings ways to deal with it.' Bodywhys (The Eating Disorders Association of Ireland) – – (01) 210 7906 – alex@

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