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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_6 | Pages 56 - 56
2 May 2024
O'Sullivan D Davey M Woods R Kenny P Doyle F Gheiti AC
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The aim of this study was to analyze and compare clinical, radiological and mortality outcomes of patients who underwent cemented hip hemiarthroplasty for displaced neck of femur fractures using a SPAIRE technique when compared to a pair-matched control cohort who underwent the same procedure using the direct lateral approach.

A retrospective review of patients who underwent cemented hip hemiarthroplasty for displaced neck of femur fractures by a single surgeon using a SPAIRE technique over a two-year period between July 2019 and July 2021 was performed. These were subsequently pair matched in a 5:1 ratio for age, gender, ASA grade and residential status with a control group who underwent cemented hip hemiarthroplasty by 4 other surgeons using a direct lateral approach

The study included a total of 240 patients (40 and 200 pairmatched to SPAIRE and control groups respectively), with a mean age of 81.0 ± 8.2 years (63–99) and a mean follow-up of 12 ± 3 months (3–30). Overall, there was no significant difference in any of the radiological or mortality outcome scores assessed between the SPAIRE and control groups (p > 0.05 for all). There was a significantly lower number of patients in the SPAIRE group who dropped a level of mobility from their pre-injury baseline at 30-days post-operatively (8.1% versus 31.6%; p = 0.003). However, this appeared to have resolved at 120-day follow-up with no significant differences between the groups in terms of those acquiring a new baseline mobility at 120-days post-operatively (2.7% versus 13.2%, p = 0.09).

In cases of cemented hip hemiarthroplasty for displaced intracapsular neck of femur fractures, the SPAIRE technique appears to offer patients an earlier return to levels of baseline pre-injury mobility when compared to a direct lateral approach.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_12 | Pages 38 - 38
1 Dec 2022
Sheridan G Hanlon M Welch-Phillips A Spratt K Hagan R O'Byrne J Kenny P Kurmis A Masri B Garbuz D Hurson C
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Hip resurfacing may be a useful surgical procedure when patient selection is correct and only implants with superior performance are used. In order to establish a body of evidence in relation to hip resurfacing, pseudotumour formation and its genetic predisposition, we performed a case-control study investigating the role of HLA genotype in the development of pseudotumour around MoM hip resurfacings.

All metal-on-metal (MoM) hip resurfacings performed in the history of the institution were assessed. A total of 392 hip resurfacings were performed by 12 surgeons between February 1st 2005 and October 31st 2007. In all cases, pseudotumour was confirmed in the preoperative setting on Metal Artefact Reduction Sequencing (MARS) MRI. Controls were matched by implant (ASR or BHR) and absence of pseudotumour was confirmed on MRI. Blood samples from all cases and controls underwent genetic analysis using Next Generation Sequencing (NGS) assessing for the following alleles of 11 HLA loci (A, B, C, DRB1, DRB3/4/5, DQA1, DQB1, DPB1, DPA1). Statistical significance was determined using a Fisher's exact test or Chi-Squared test given the small sample size to quantify the clinical association between HLA genotype and the need for revision surgery due to pseudotumour.

Both groups were matched for implant type (55% ASR, 45% BHR in both the case and control groups). According to the ALVAL histological classification described by Kurmis et al., the majority of cases (63%, n=10) were found to have group 2 histological findings. Four cases (25%) had group 3 histological findings and 2 (12%) patients had group 4 findings. Of the 11 HLA loci analysed, 2 were significantly associated with a higher risk of pseudotumour formation (DQB1*05:03:01 and DRB1*14:54:01) and 4 were noted to be protective against pseudotumour formation (DQA1*03:01:01, DRB1*04:04:01, C*01:02:01, B*27:05:02).

These findings further develop the knowledge base around specific HLA genotypes and their role in the development of pseudotumour formation in MoM hip resurfacing. Specifically, the two alleles at higher risk of pseudotumour formation (DQB1*05:03:01 and DRB1*14:54:01) in MoM hip resurfacing should be noted, particularly as patient-specific genotype-dependent surgical treatments continue to develop in the future.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_13 | Pages 143 - 143
1 Nov 2021
McCarthy C Mahon J Sheridan G Welch-Phillips A O'Byrne J Kenny P
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Introduction and Objective

Ceramic on Ceramic bearings in Total Hip Arthroplasty (THA) afford a low friction coefficient, low wear rates and extreme hardness. Significant complications include hip squeak, ceramic fracture and poor polyethylene performance in revision procedures due to imbedding of abrasive microscopic ceramic fragments. We report on the results of this bearing at a minimum of 10 years.

Materials and Methods

A single-centre retrospective review of 449 THAs was performed. Primary outcome measures included aseptic revision and all-cause revision rates at a minimum of 10 years post operatively. Evaluation of functionality was performed with WOMAC and SF-36 scores which were performed pre-operatively and at intervals of 6 months, one year, 2 years, 5 years and 10 years post operatively.


Bone & Joint Open
Vol. 1, Issue 12 | Pages 743 - 748
1 Dec 2020
Mahon J McCarthy CJ Sheridan GA Cashman JP O'Byrne JM Kenny P

Aims

The Exeter V40 cemented femoral stem was first introduced in 2000. The largest single-centre analysis of this implant to date was published in 2018 by Westerman et al. Excellent results were reported at a minimum of ten years for the first 540 cases performed at the designer centre in the Exeter NHS Trust, with stem survivorship of 96.8%. The aim of this current study is to report long-term outcomes and survivorship for the Exeter V40 stem in a non-designer centre.

Methods

All patients undergoing primary total hip arthroplasty using the Exeter V40 femoral stem between 1 January 2005 and 31 January 2010 were eligible for inclusion. Data were collected prospectively, with routine follow-up at six to 12 months, two years, five years, and ten years. Functional outcomes were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Outcome measures included data on all components in situ beyond ten years, death occurring within ten years with components in situ, and all-cause revision surgery.


Bone & Joint Open
Vol. 1, Issue 6 | Pages 261 - 266
12 Jun 2020
Fahy S Moore J Kelly M Flannery O Kenny P

Aims

Europe has found itself at the epicentre of the COVID-19 pandemic. Naturally, this has placed added strain onto healthcare systems internationally. It was feared that the impact of the COVID-19 pandemic could overrun the Irish healthcare system. As such, the Irish government opted to introduce a national lockdown on the 27 March 2020 in an attempt to stem the flow of admissions to hospitals. Similar lockdowns in the UK and New Zealand have resulted in reduced emergency department presentations and trauma admissions. The aim of this study is to assess the effect of the national lockdown on trauma presentations to a model-3 hospital in Dublin, Ireland.

Methods

A retrospective study was conducted. All emergency department presentations between 27 March 2019 to 27 April 2020 and 27 March 2020 to 27 April 2020 were cross-referenced against the National Integrated Medical Imaging System-Picture Archiving Communication System (NIMIS-PACS) radiology system to identify those with radiologically proven skeletal trauma. These patients were grouped according to sex, age, discharge outcome, mechanism of injury, and injury location.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_15 | Pages 107 - 107
1 Nov 2018
Sheridan G Kelly R McDonnell S Kenny P
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This was a retrospective study of registry data from a National Orthopaedic Hospital for all THRs with 10-year follow-up data. Inclusion criteria were all THRs with a minimum of 10-year follow-up data. All metal-on-metal (MoM) THRs and MoM resurfacings were excluded from the analysis due to the high rate of revision associated with these bearings. Univariate and multivariate analyses controlling for confounding variables were performed to compare outcomes. A total of 1,697 THRs were performed in 1,553 patients. The four significant predictors for revision were fixation type (p<0.01), surface bearing type (p<0.01), age (P<0.05) and head size (p<0.05). Gender, BMI and approach had no effect on revision rates. The lowest 10-year all-cause revision rates were seen in cemented THRs at 1.7%. Ceramic-on-poly bearings had the lowest revision rate at only 1.2%. Metal-on-poly bearings had a 1.7% revision rate. Ceramic on ceramic bearings had a 7.1% revision rate with 1 revision for squeak and 1 revision for ceramic head fracture. The causes for revision in order of decreasing frequency were as follows: Infection (n=13, 0.7%), dislocation (n=7, 0.4%), periprosthetic fracture (n=3, 0.2%) and aseptic loosening (n=2, 0.1%). There were 2 re-revisions at 10 years in total. The smaller 22.225mm head sizes had a significantly lower revision rate than other head sizes (p<0.05). Ceramic-on-poly bearings, cemented fixation and smaller head sizes perform better in the experience of this registry. However, with multivariate analysis, these differences were shown to be insignificant.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 189 - 189
1 Sep 2012
Murphy C O'Flanagan S Keogh P Kenny P
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Introduction

The emergence of a new variant of subtrochanteric stress fractures of the femur affecting patients on oral bisphosphonate therapy has only recently been described. This fracture is often preceded by pain and distinctive radiographic changes, and associated with a characteristic fracture pattern. We undertook a review of this cohort of patients in our service.

Method

A retrospective review was carried out looking for patients with subtrochanteric fractures who were taking oral bisphosphonates presenting with a low velocity injury over a two year period. Clinical data and radiographs were assessed.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 187 - 187
1 Sep 2012
Lui D Hayes DB Seamus M Kenny P McElwain J Bennett D
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Aims

Hip fractures pose a significant burden on the healthcare system. Hyperglycaemia and a state of Type 2 diabetes exists post operatively. Being normoglycaemic has well documented benefits. Pre operative carbohydrate loading has been shown to have two good effects. It decrease hyperglycaemia post operatively and allows the patient to undergo less strict fasting protocols. Insulin resistance to date has not been examined in these patients and this was determined using a validated formula (HOMA/IR).

Methods

Three trauma hospitals were enrolled and patients with hip fractures requiring operative fixation were enlisted. Exclusion criteria: diabetic patients and inability to imbibe. 100 neck of femur fractures were examined. 46 patients were fasted normally. 32 test patients were given a carbohydrate rich drink pre operatively the night before surgery and in the morning up to 2 hours prior to surgery. 22 patients were excluded. Serum random glucose and insulin levels were taken on admission. Fasting serum glucose and insulin levels were taken on day one post operatively.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 210 - 210
1 Sep 2012
Cummins F Kelly D Kenny P
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Background and purpose

The two most common complications of femoral impaction bone grafting are femoral fracture and massive implant subsidence. We investigated fracture forces and implant subsidence rates in embalmed human femurs undergoing impaction grafting. The study consisted of two arms, the first examining the force at which femoral fracture occurs in the embalmed human femur, and the second examining whether significant graft implant/subsidence occurs following impaction at a set force at two different impaction frequencies.

Methods

Using a standardized impaction grafting technique with modifications, an initial group of 17 femurs underwent complete destructive impaction testing, allowing sequentially increased, controlled impaction forces to be applied until femoral fracture occurred. A second group of 8 femurs underwent impaction bone grafting at constant force, at an impaction frequency of 1 Hz or 10 Hz. An Exeter stem was cemented into the neomedullary canals. These constructs underwent subsidence testing simulating the first 2 months of postoperative weight bearing.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVII | Pages 29 - 29
1 May 2012
Brennan S Walls R Murphy D Kenny P Keogh P O'Flannagan S
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Conservative management remains the gold standard for many fractures of the humeral diaphysis with union rates of over 90% often quoted. Success with closed management however is not universal.

Phase 1

A retrospective review of all conservatively managed fractures between 2001 and 2005 was undertaken to investigate a suspected high non-union rate and identify possible causes. The overall non-union rate was 39.2% (11 of 28 cases). There was no difference in axial distraction at presentation, however following application of cast there was significantly more distraction in the non-union group (1.2 v 5.09mm, p<0.01).

Changes to practise

All humeral fractures were admitted, lightweight U-slabs were applied by a technician, distraction was avoided, patients abstained from NSAIDS, consultant reviewed radiographs before discharge and patients were converted early to functional brace.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVII | Pages 26 - 26
1 May 2012
Judd S Shaju A Keogh P Kenny P O'Flanagan S
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Introduction

A comprehensive met-analysis of anterior knee pain post intramedullary nailing of the tibia was performed by Katsoulis et al in 2006. The principle findings were that 47.4% of patients had anterior knee pain at 2 years post tibial nailing. Worse results were found following a patella tendon splitting approach when compared with a medial para-patellar tendon approach. These conclusions were drawn from 20 studies including 1460 patients.

Currently both approaches to the proximal tibia for nailing are used at JCMH Blanchardstown. A retrospective study was performed to compare the results of tendon splitting and tendon sparing approaches to tibial nails and to compare the results of JCMH with those stated in literature.

Method

Patients who underwent tibial nailing in 2007 and 2008 were identified using the hospital coding system. Those patients who were treated under the care of Mr Kenny had a medial para-tendinous approach and those treated the care of Mr O'Flanagan and Mr Keogh had a tendon splitting approach. Apart from the approach the nailing technique using the Trigen Knee Nail and the post operative physiotherapy protocol were identical.

Follow up included questions regarding knee pain and return to previous function. Specifically: Knee pain that affects daily life, Knee pain on kneeling, Knee pain on ascending or descending stairs, Return to work and Return to sports or active hobbies.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVII | Pages 14 - 14
1 May 2012
Gheiti AC Kegan C Boran S Kenny P
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Introduction

Surgical experience has been shown to improve the clinical outcomes in Total hip arthroplasty. The objective of this study was to compare clinical and radiological outcomes between Consultants and NCHDs grade surgeons for the Exeter total hip replacement taken from the Cappagh National Orthopaedic Hospital Joint Register.

Methods & Materials

Between 2005 and 2008, 2749 primary total hip replacements were done, 433(15.78%) were Exeter total hip system. 380(86%) out of 433 were included in the study, 227(59%) were females and 154(41%) were males. A consultant was the primary surgeon for 193(51%) patients and an NCHD was the primary surgeon for 187(49%) patients. Mean age, at time of operation was 68 years. Clinical outcome was assessed with WOMAC and SF36 scoring system. Patients were invited to fill in the WOMAC and SF36 questionnaire, pre-operatively, at 6 months and at 2 years after the operation. Radiographs were evaluated for radiolucency with a standardized technique.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVII | Pages 25 - 25
1 May 2012
Molloy A Keeling P Almanasra A Gunkelman T Kenny P O'Flanagan S Eustace S Keogh P
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Introduction

The incidence of osteochondral lesions following ankle fractures varies in the literature between 17-70%. They are commonly associated with chronic pain and swelling in patients diagnosed with such pathology. There is less evidence about the relationship between OCL and the development of post-traumatic osteoarthritis, the most common type of ankle arthritis.

Methods

Through the use of MRI 8 weeks following ankle fractures, we investigated the incidence of OCL in patients treated both surgically and conservatively for ankle fractures of all AO subtypes.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVII | Pages 41 - 41
1 May 2012
Cummins F Kenny P Kelly D
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Summary

A laboratory based study investigating fracture forces and implant subsidence rates in embalmed human femurs undergoing impaction grafting.

Methods

Human femurs were harvested from cadavers for destructive impaction testing. An initial group of femurs underwent destructive impaction testing, using the impaction grafting technique as described by Gie et al, modified, allowing increasing, controlled impaction forces to be applied until femoral fracture occurred.

A second group of embalmed human femurs underwent impaction bone grafting at constant force, with varied impaction frequencies. An Exeter stem was cemented into the neo-medullary canals. These constructs underwent subsidence testing simulating the first 2 months post-operative weight-bearing.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IV | Pages 27 - 27
1 Mar 2012
Flannery O O'Reilly P Britton J Mahony N Prendergast P Kenny P
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The process of femoral impaction grafting requires vigorous impaction to obtain adequate stability but the force of impaction has not been determined. This process has been reported to result in femoral fractures with rates reaching 16%. The aims of this study were to determine the threshold force required for femoral impaction grafting, to determine the affect cortical thickness, canal diameter and bone mineral density (BMD) have on this threshold force and to measure subsidence of an Exeter prosthesis following impaction at the threshold force.

Adult sow femurs were prepared and placed through a DEXA scanner and the BMD and canal diameter measured. Thirty five femurs were impacted with morsellised bone chips and an increasing force of 0.5kN was applied until the femur fractured. Using callipers the cortical thickness of the bone was measured along the fracture line. Once the threshold force was determined 5 femurs were impacted to this threshold force and an Exeter stem was cemented into the neomedullary canal and a 28mm Exeter head attached. Axial cyclic loading was performed between 440N (swing phase of gait) and 1320N (stance phase of gait) for 150,000 cycles at a frequency of 3Hz. The position sensor of the hydraulic testing machine measured the subsidence.

29 tests were successfully completed. The threshold force was found to be 4kN. There was no significant correlation between the load at fracture and the cortex: canal ratio or the bone mineral density. Following impaction with the maximum force of 4kN the average subsidence for the 5 femurs was 0.276mm (range 0.235 – 0.325mm). In this animal study the threshold force was 4kN. Minimal axial subsidence of the implant occurred when impacting the graft with this threshold force. We therefore achieved a stable construct without fracture which is the ultimate goal for the revision hip surgeon.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 581 - 582
1 Oct 2010
Murphy M Flannery O Kenny P Keogh P Lui D Mc Hugh G O’Flanagan S Orakzai S
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Introduction: K wiring is a popular technique to help maintain anatomic reduction of distal radial fractures. It has the advantage of being a semi-closed procedure, which is simple to perform. Complications related to K wires include infection, migration and damage to tendons and nerves.

We aimed to perform a randomized prospective study to determine the outcome of Buried versus Exposed K wire placement.

Methods: We prospectively recruited 60 consecutive patients with displaced distal radius fractures requiring K wiring to our study. They were randomized to Buried versus Exposed K wire groups.

Patient details were collected and follow up was performed at 2 and 6 weeks post op.

Infection at pin sites was measured on a 0 to 6 point scale. Superficial radial nerve was assessed with light touch and 2 point discrimination. EPL tendon was also assessed for damage.

Results: 60 consecutive patients were recruited to the study and randomized to buried or exposed k wires. There were 30 patients in each group.

No damage to EPL tendon was recorded in either group at 6/52 follow up.

There was a slight increased rate of superficial infection at exposed pin sites noted at 2/52 follow up however this was not seen at the 6/52 follow up. Superficial radial nerve damage was noted in one case only. This was in the buried k wire group and occurred following removal of the radial wire.

Conclusion: There appears to be slight increased risk of superficial pin site infection in the exposed k wire group at 2/52 but this is not seen at 6/52 follow up. Buried k wires require a second procedure to remove the wires and this runs the risk of superficial radial nerve damage.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 279 - 279
1 May 2010
Mac Niocaill R Britton J Lennon A Kenny P Prendergast P
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The main mode of failure of the acetabular component in total hip arthroplasty is aseptic loosening. Successive generations of cementation techniques have evolved to alleviate this problem.

This paper evaluates one such method, Negative Pressure Intrusion cementation. Two groups of machined bovine cancellous bone samples were created; experimental (n = 26) and control (n = 26). The experimental group was cemented using the negative pressure technique and control group was cemented in the absence of negative pressure. The relative cement intrusion depths were then assessed for each group using MicroCT. These samples were then further machined and tested to failure in torsion to estimate their mechanical properties.

Results show mean cement intrusion depth for the negative pressure group to be 8676μm and 6042 μm for the control group (p = 0.078). Mechanical testing also revealed a greater mean torque in the negative pressure group (1.6223Nm vs 1.2063Nm) (p = 0.095).

This work quantifies the effect of negative intra-osseous pressure on cement intrusion depth in cancellous bone and for the first time relates this to increased mechanical strength.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 50 - 51
1 Mar 2010
Murphy M Flannery O McHugh G Lui D Kenny P Keogh P O’Flanagan S
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Introduction: K wiring is a popular technique to help maintain anatomic reduction of distal radial fractures. It has the advantage of being a semi-closed procedure, which is simple to perform. Complications related to K wires include infection, migration and damage to tendons and nerves.

We aimed to perform a randomized prospective study to determine the outcome of Buried versus Exposed K wire placement.

Methods: We prospectively recruited 60 consecutive patients with displaced distal radius fractures requiring K wiring to our study. They were randomized to Buried versus Exposed K wire groups.

Patient details were collected and follow up was performed at 2 and 6 weeks post op.

Infection at pin sites was measured on a 0 to 6 point scale. Superficial radial nerve was assessed with light touch and 2 point discrimination. EPL tendon was also assessed for damage.

Results: 60 consecutive patients were recruited to the study and randomized to buried or exposed k wires. There were 30 patients in each group.

No damage to EPL tendon was recorded in either group at 6/52 follow up.

There was a slight increased rate of superficial infection at exposed pin sites noted at 2/52 follow up however this was not seen at the 6/52 follow up. Superficial radial nerve damage was noted in one case only. This was in the buried k wire group and occurred following removal of the radial wire.

Conclusion: There appears to be slight increased risk of superficial pin site infection in the exposed k wire group at 2/52 but this is not seen at 6/52 follow up. Buried k wires require a second procedure to remove the wires and this runs the risk of superficial radial nerve damage.

Thus it would appear that leaving k wires exposed is the safer and more convenient method of K wiring the displaced distal radius fracture.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 43 - 43
1 Mar 2010
Egan C Cummins F O Connor P Kenny P
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Aim: It is widely accepted that surgical skills improve with experience. Part of this experience comes from operating on patients while honing new skills. Total hip arthroplasty is one such procedure. This paper examines outcomes in relation to the primary surgeon

Methodology: All patients who had an Exeter femoral component implanted and 2 years follow-up in the hospital joint register had their X-Ray, outcome scores and complications reviewed. Complications are routinely recorded as part of the joint register and hospital computer discharge system. Radiological outcome measures were taken as recommended by Johnston et al. Procedures were recorded as either performed by consultant surgeon or registrar supervised by consultant surgeon.

Results: Post operative WOMAC scores at six months and 2 years were similar in both groups (Consultant 19.6, registrar 22.32 at 6 months) SF-36 figures were similar at six months (Consultant performed 78.56, consultant supervised 75.39). There was a difference in SF-36 at 2 years (72.77 vs 63.11) but this was not statistically significant. Average abduction angle was lower in consultant supervised than consultant performed procedure. (36.75 vs 47 deg) Barrack cement grading was similar in both groups. Consultant inserted stems were more likely to be in neutral position compared to consultant supervised stems (84% vs 56%)

Conclusion: In both goups the quality of life indexes do show a difference in outcome which relates to the primary surgeon.. However decreased abduction angle may lead to decreased range of motion post operatively and should be addressed intraoperatively.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 52 - 53
1 Mar 2010
Oduwole K Codd M Byrne F O’Byrne J Kenny P
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Introduction: Despite the documented benefits, some countries have yet to agree on the establishment of a national arthroplasty registry.

Aim: The objective of this study was to determine the opinions regarding the establishment of an Irish National register from the Consultant Orthopaedic Surgeons and Senior Orthopaedic trainees in Ireland. We also aim to find the possible reasons why a national joint register has not been established in Ireland.

Method: We have undertaken a questionnaire study to sample the opinions of the Consultant orthopaedic surgeons and Specialist registrars(SR), regarding establishment of an Irish national joint register. The questions asked related to opinions about the setting up, purpose and maintenance of an Irish National Joint Register.

Results: A total of 79 responses were received of 114 questionnaires distributed (a 69% first response rate). 97% believe it is time we set up a registry, 94% will contribute and 81% say it should be made compulsory for unwilling Surgeons and Hospitals to participate. 82% of respondents felt the set up cost should be borne by the government (Health Service Executive). Only10% of consultants agreed that the IOA should be involved in the cost bearing. Despite the overwhelming support for a national register, privacy and liability issues were major concern. 58% of the total respondents strongly agree/agree that access to registry report by the general public can expose surgeons and Hospitals to a medicolegal loophole; hence access to database should be restricted. 78% strongly agree/agree that the registry data may be used as benchmarking tools by the administrators of health-care systems to discriminate methods, implants, surgeons and hospitals, which are found to be underperforming.

Conclusion: There are considerable logistical challenges involved in the establishment of any registry. Other countries have done it successfully, and the benefits are well documented. This subject has endorsement from the Professionals as demonstrated by this study. In a litigious society such as ours, legislation may be required to further protect the integrity of a national joint replacement registry to ensure that the data are used as intended—to serve as an early warning system for premature device failure and to improve outcomes for our patients.