Cappagh National Orthopaedic Hospital

Geographic distribution of healthcare workers is an issue most countries are challenged with. Regionalisation of surgical training in Ireland has emerged as a hot topic over the past number of years in an effort to address the balance between professional progression, adequacy of surgical training and personal responsibility/circumstance. This issue has been reported on within the NHS, but the way in which it may apply to Irish surgical specialties is now being considered. Our aim was to examine the sentiments of Irish Trauma and Orthopaedic trainees towards a number of issues as they pertain to regionalisation of training. We distributed a questionnaire amongst the HST Trauma and Orthopaedic group of trainees and assimilated the results. We found that 69.1% of trainees felt the current structure of the Irish Trauma and Orthopaedic training system was fit for purpose. Ninety percent of respondents said the current structure of the training scheme puts strain on their personal life and work-life balance. When asked if trainees felt that regionalisation of the training programme would benefit their training, 43.9% replied no, 31% yes and 26.2% were unsure. When asked if, overall, the trainee would be in favour of a regionalised training structure for Trauma and Orthopaedics, 43% said 'No', 40% said 'Yes' and 17% were unsure. An equilibrium of professional surgical progression, optimal patient care and work-life balance is a goal held in the highest regard amongst key stakeholders of Irish surgical training. The solution amongst the various surgical subspecialties may not be a one-size-fits-all approach in pursuit of the optimisation of this balance. Further engagement of key stakeholders in how surgical training will evolve over time is crucial in order to achieve this.

BackgroundAcromioplasty is frequently performed during arthroscopic rotator cuff repair (ARCR) to address subacromial impingement, though its clinical value remains debated. This meta-analysis examines whether acromioplasty improves functional outcomes, pain relief, or re-tear rates in patients undergoing ARCR for full-thickness rotator cuff tears.MethodsA systematic search of PubMed, Embase, Cochrane Library, and Scopus was conducted in accordance with PRISMA (Preferred Reporting Items for Sys­tematic Reviews and Meta-Analyses) guidelines to identify randomized controlled trials (RCTs) from 2011 to 2023. Six RCTs comparing ARCR with and without acromioplasty were included. Primary outcomes included functional scores of American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff Index, University of California, Los Angeles scores, pain levels (visual analog scale [VAS]), and re-tear rates. Data were pooled using a random-effects model. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsAcross 574 patients, both groups demonstrated improvement in functional outcomes. The acromioplasty group showed a modest advantage (e.g., ASES score: mean difference, 2.93), but these gains did not exceed the minimal clinically important difference. There were no significant differences in pain relief (as measured by VAS) or re-tear rates between groups. The risk of bias was moderate in some trials due to a lack of blinding. GRADE assessment rated evidence as high for ASES scores and moderate for other outcomes.ConclusionsAcromioplasty offers statistically modest improvements in shoulder function but does not meaningfully enhance pain relief or reduce re-tear rates. Given these findings, the routine use of acromioplasty in ARCR is not supported; however, select patients may benefit based on individual anatomical or clinical factors.Level of evidenceI.

May-Thurner syndrome (MTS) is a clinicopathological condition where the left common iliac vein is compressed by the overlying right common iliac artery, potentially leading to deep vein thrombosis (DVT) or obstruction to venous outflow. Unlike in DVT due to other causes, pulmonary embolism is not a frequent association of MTS. We report a man in his 30s who presented with left lower limb pain and swelling, without chest pain or shortness of breath. A contrast CT angiography of the abdomen and pelvis revealed a left common iliac, external iliac and femoral extensive DVT due to MTS. Incidental bilateral segmental pulmonary emboli were detected at the covered lung bases. He underwent direct catheter thrombolysis of his left side DVT and later a stent placement in the common iliac vein. This report highlights the under-recognised presentation of MTS in patients with DVT and emphasises the role of early endovascular intervention in improving clinical outcomes and preventing long-term complications.

Background: Meta-analyses and randomized controlled trials were inconclusive regarding the role of gabapentinoids in patients undergoing joint arthroplasties. The aim of the present study was to investigate the effect of a preoperative low dose of gabapentin in patients undergoing total hip (THA) and knee arthroplasties (TKA). Methods: A retrospective observational study was conducted on 135 patients undergoing THA and TKA at the National Orthopedic Hospital Cappagh, Dublin, from July to December 2022. The primary outcome was the assessment of numerical rating scores (NRS) for postoperative pain at various time intervals. Results: During the observation period, 55 patients received a preoperative dose of gabapentin, while 80 patients did not. Statistically significant differences in numerical rating scores (NRS) were found at 6 (3 vs. 0, p < 0.001), 12 (4 vs. 2, p < 0.001), 18 (4 vs. 3, p < 0.001), and 24 h (4 vs. 3, p = 0.010) after surgery, in favor of the group receiving gabapentin. A reduction in opioid consumption, measured as morphine equivalents, was also noted in the gabapentin group (40 vs. 30 mg, p = 0.040). Conclusions: A low preoperative dose of gabapentin was associated with reduced postoperative pain and opioid consumption in patients undergoing TKA and THA, without impacting hospital stay. Prospectively designed trials are encouraged to assess the safety and effect on pain control of a preoperative low dose of gabapentin.

Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and AimsPostoperative pain management after primary total knee arthroplasty remains the main challenge for orthopaedic anaesthesiologists. Single shot adductor canal block is widely accepted as part of multimodal analgesia reducing postoperative opiate consumption and promotes early mobilization.MethodsEthics approval was gained from the study centre. Patients scheduled for primary knee arthroplasty in a tertiary referral centre for elective orthopaedic surgery were identified and randomised into 2 groups. Group A received ultrasound guided(USG) adductor canal block(ACB) with 20mls of 0.25% levobupivacaine. Group B received a periarticular block by surgeon as per protocol plus sham USG ACB. A non-blinded anaesthesiologist, prepared the solution for adductor canal block, performed the spinal anaesthesia and looked after the patient in the operating theatre. A separate, blinded anaesthesiologist performed the USG ACB. Both groups received the same dose of spinal anaesthesia. The same intraoperative and postoperative analgesia and antiemetics were administered, with other medications at the discretion of the non-blinded anaesthesiologist. Primary outcome measures were morphine milligram equivalent(MME) at 24 and 48 hours. Secondary outcomes were time to first opiate(mins) and visual analogue pain score(VAS) at 24 and 48 hours.Results22 suitable patients were recruited and randomised into groups A and B. Mean +/- standard error 24-hour MME for test group (A) was 70+/-10.8 and for sham group (B) was 59.6+/-7.64, p=0.47. 48-hour MME for group A 72.23 +/- 22.4 and group B was 84.45+/-15.4, p=0.71.ConclusionsThere was no significant difference in primary outcomes between groups. Secondary outcomes similarly had no significant difference between groups.

The primary aim of this study was to assess functional and patient reported outcomes among those with first carpometacarpal joint osteoarthritis treated with the Pyrocardan implant (Stryker-Wright Medical) in Ireland. The secondary aim of this study was to assess implant survival and revision rates. We conducted a single surgeon retrospective study assessing 40 Pyrocardan arthroplasties among 37 patients, with a minimum of 6months follow-up. Patient reported outcomes were assessed via quick disability of the arm, shoulder and hand (quick DASH) questionnaire, the visual analog score (VAS) for pain, and patient rated wrist evaluation (PRWE) questionnaire. Functional scores were assessed via lateral key pinch strength and Kapandji scores. Implant survival, complication and revision rates were also recorded. Forty Pyrocardan implants among 37 patients were included. Mean follow-up was 2.5years with a 97.5% implant survival rate. One patient underwent revision to trapeziectomy and Weilby sling. Eighty-eight percent of survey responders admitted that they would undergo the operation again, and 75% declared a 75-100% improvement in symptoms. Post-operative pain scores include a mean VAS of 2.07, quickDASH of 22.82, and PRWE of 26.92. Of those tested, there was an average increase in post-operative lateral key pinch, and 89% obtained a post-operative Kapandji score equal to or better than pre-operative scores. This is the first study assessing the Pyrocardan interpositional arthroplasty in Ireland. The implant appears to produce good functional and patient reported outcomes. There is high satisfaction and low revision rate, producing a reliable and successful surgical technique for treating CMC joint osteoarthritis.

While growth factors have the potential to halt degeneration and decrease inflammation in animal models, the literature investigating the effect of dosage on human cells is lacking. Moreover, despite the completion of clinical trials using growth differentiation factor-5 (GDF-5), no results have been publicly released. The overall objective was to quantitatively assess the effect of three clinically relevant concentrations of GDF-5 (0.25, 1, and 2 mg) as a therapeutic for disc regeneration. Firstly, this work experimentally determined the effects of GDF-5 concentration on the metabolic and matrix synthesis rates of human nucleus pulposus (NP) cells. Secondly, in silico modeling was employed to predict the subsequent regenerative effect of different GDF-5 treatments (± cells). This study suggests a trend of increased matrix synthesis with 0.25 and 1 mg of GDF-5. However, 2 mg of GDF-5 significantly upregulates oxygen consumption. Despite this, in silico models highlight the potential of growth factors in promoting matrix synthesis compared to cell-only treatments, without significantly perturbing the nutrient microenvironment. This work elucidates the potential of GDF-5 on human NP cells. Although the results did not reveal statistical differences across all doses, the variability and response among donors is an interesting finding. It highlights the complexity of human response to biological treatments and reinforces the need for further human research and personalized approaches. Furthermore, this study raises a crucial question about whether these potential biologics are more regenerative in nature or better suited as prophylactic therapies for younger patient groups. Biological agents exhibit unique characteristics and features, demanding tailored development strategies and individualized assessments rather than a one-size-fits-all approach. Therefore, the journey to realizing the full potential of biological therapies is long and costly. Nonetheless, it holds the promise of revolutionizing spinal healthcare and improving the quality of life for patients suffering from discogenic back pain.

Background: Joint-preserving hip operations can help relieve pain and delay the need for long-term joint arthroplasty. Previous research has not identified procedures that can compromise outcomes following total hip arthroplasty (THA). This meta-analysis aims to evaluate the effect of joint-preserving hip operations on outcomes following subsequent THA. Methods: MEDLINE, EMBASE and Scopus databases were searched from the date of inception until February 2024. All studies comparing outcomes following THA in individuals with (PS) and without prior surgery (NPS) of the femur or pelvis were included. Data on operative time, blood loss, intra- and post-operative complications, functional outcomes, and implant survivorship were extracted. Results: 16 studies, comprising 2576 patients were included (PS = 939, NPS = 1637). The PS group was associated with significantly longer operative time [MD: 8.1, 95% CI: 4.6–11.6], significantly greater blood loss [MD: 167.8, 95% CI: 135.6–200.0], and a higher risk of intra-operative peri-prosthetic fracture [RR: 1.9, 95% CI: 1.2–3.0], specifically, with prior femoral osteotomy. There were no differences in terms of risks of dislocation [RR: 1.8, 95% CI: 1.0–3.2], implant loosening [RR: 1.0, 95% CI: 0.7–1.5], or revision surgery [RR: 1.3, 95% CI: 1.0–1.7] between the two groups. The PS group was associated with significantly poorer improvements in functional outcome [MD: −5.6, 95% CI: −7.6–(−3.5)], specifically, with prior acetabular osteotomy. Implant survivorship in the two groups was comparable after one year [HR: 1.9, 95% CI: 0.6–6.2] but significantly inferior in the PS group after five years [HR: 2.5, 95% CI: 1.4–4.7], specifically, with prior femoral osteotomy. Conclusion: Joint-preserving hip operations are associated with greater intra-operative challenges and complications. In subsequent joint arthroplasty, prior acetabular procedures affect functional outcomes while prior femoral procedures influence implant survivorship. Hip pain due to the morphological sequelae of pediatric hip pathology can be debilitating at a young age. Surgical decision-making at that time needs to consider the survivorship of a THA implanted at that young age against the consequences of hip preservation surgery on further THA.