An independent clinical audit has revealed that a significant number of hip surgeries performed on children at two Dublin hospitals were unwarranted. The review, commissioned by the Health Service Executive (HSE), examined 147 cases of pelvic osteotomy procedures conducted between 2021 and 2023 at Children’s Health Ireland (CHI) Temple Street, the National Orthopaedic Hospital Cappagh (NOHC), and CHI Crumlin. The audit found that nearly 70% of surgeries at Temple Street and Cappagh did not meet established international criteria for developmental dysplasia of the hip (DDH), a condition where the hip joint is improperly formed.
Audit Findings and Clinical Concerns
The audit, led by consultant paediatric orthopaedic surgeon Simon Thomas from Bristol Royal Hospital for Children, identified that 60% of surgeries at Temple Street and 79% at Cappagh were performed on children who did not meet the standard thresholds for surgical intervention. In contrast, CHI Crumlin demonstrated adherence to international surgical criteria, with only one of 63 cases falling outside recommended guidelines.
The procedures in question involved pelvic osteotomies, where bones of the pelvis are cut and reshaped to improve hip joint alignment. The audit noted the use of a novel surgical technique at Temple Street and Cappagh, raising concerns about the decision-making process and the criteria used to determine surgical necessity.
One child experienced complications resulting from surgery that did not meet the recommended criteria, highlighting the potential risks associated with unnecessary procedures.
Institutional Responses and Future Actions
In response to the audit, CHI CEO Lucy Nugent acknowledged the findings and expressed regret that not all patients received consistent and high-quality care. She assured that affected families are being contacted and will receive support and information regarding next steps.
Angela Lee, CEO of NOHC, also apologized for the distress caused by the audit’s findings and emphasized the hospital’s commitment to implementing the recommended changes.
The HSE has initiated plans to review approximately 1,800 cases of pelvic osteotomy surgeries performed at Temple Street and Cappagh since 2010. This comprehensive review aims to ensure long-term follow-up and care for all affected patients.
Health Minister Jennifer Carroll MacNeill emphasized the importance of clinical follow-up and care for patients who underwent these surgeries. She confirmed that letters have been sent to families to provide information and support, and that an international panel of experts will be established to review individual cases upon request.
Taoiseach Micheál Martin described the audit’s findings as “very serious” and indicated that issues related to clinical performance and governance at CHI hospitals must be addressed. He suggested that a broader clinical review is likely necessary.
Opposition parties, including Sinn Féin and the Social Democrats, have called for further investigation into the matter. Sinn Féin’s Health Spokesperson David Cullinane highlighted the need for timely answers for concerned parents, while Social Democrats TD Sinéad Gibney emphasized the importance of an independent review process with a clear timeline.
A dedicated helpline has been established to assist affected families. The freephone line, 1800 807 050, is available Monday to Friday from 8am to 8pm, and Saturday and Sunday from 9am to 5pm.