Latest news with #SimonThomas
Business Standard
02-06-2025
- Health
- Business Standard
Top Surgeons from India and Germany Collaborate to Excel in Complex Revision Knee Replacement Procedures
PNN New Delhi [India], June 2: In a landmark event held at Max Hospital Shalimar Bagh leading Indian Orthopaedic & Robotic Joint replacement Surgeon Dr Simon Thomas collaborated with world-renowned specialist in Revision Knee replacement surgeon Dr Wolfgang Klauser, Chief in Surgeon & Medical Director, at Ostseeklinik Damp, Germany for a workshop to achieve excellence in Revision knee replacement. What is revision knee replacement: Revision knee replacement is a surgical procedure to replace a previously implanted knee prosthesis that has failed or developed complications. It is more complex than the initial (primary) knee replacement due to factors like scar tissue, bone loss, and altered anatomy. Revision is typically required due to: 1. Implant Loosening: Aseptic failure where the implant detaches from the bone over time. 2. Infection (Periprosthetic Joint Infection): Bacterial colonization of the implant, often requiring staged surgery. 3. Periprosthetic Fracture: Bone break near the implant, often due to trauma or osteoporosis. 4. Instability: Imbalance in ligaments or soft tissues causing joint dysfunction. 5. Wear & Tear: Polyethylene component degradation over decades. 6. Implant Malalignment: Improper positioning leading to uneven stress and pain. 7. Stiffness: Severe loss of motion unresponsive to conservative treatment. Dr Simon Thomas at Max Hospital centre of excellence for revision knee replacement informs about factors that determine the best outcomes of revision knee replacement, they are: 1. Accurate Diagnosis: * Identify failure cause (e.g., infection via synovial fluid analysis, imaging). * Use advanced imaging (CT, MRI, radiographs) to assess bone loss and implant position. 2. Preoperative Planning: * Customized surgical approach based on bone defects (e.g., bone grafts, augments). * Select appropriate revision implants (e.g., constrained designs, stems, tantalum cones). 3. Surgical Expertise: * Surgeon experience in complex revisions to manage technical challenges (e.g., bone loss, ligament balancing). * Use of technologies like navigation or robotics for precise alignment (where applicable). 4. Infection Management: * Multidisciplinary care with infectious disease specialists. * Staged approach: Remove infected implant, administer antibiotics, then re-implant. 5. Patient Optimization: * Control comorbidities (diabetes, obesity), encourage smoking cessation, and improve nutrition. * Address osteoporosis to enhance bone-implant fixation. 6. Intraoperative Techniques: * Ensure proper implant fixation (cemented vs. hybrid). * Address ligament instability and restore joint line alignment. 7. Postoperative Care: * Aggressive physical therapy to restore mobility and strength. * Infection prophylaxis and anticoagulation to prevent clots. * Long-term monitoring for signs of failure. "Our vision is to deliver one of the best revision knee replacements centres in the country and joint workshops with international faculty is of great value to that" said Dr Simon Thomas.
RTÉ News
23-05-2025
- Health
- RTÉ News
Questions from hip audit to take many months to answer
The questions raised by the independent audit of children's hip surgeries will take many months, perhaps even longer, to answer. It will bring a period of great worry for parents and young children waiting to see if they are part of the patients where it was deemed surgery was not indicated. The issue first emerged after concerns were raised with Children's Health Ireland by a whistleblower about the thresholds being applied when making the decision to undertake surgery for children with Developmental Hip Dysplasia (DHD). Around 1,800 children and young adults will be offered a review and some of these are already under way. However, the process is expected to take around six months and will use external experts. One of the major findings from the audit is that the percentages of pelvic osteotomies not reaching the criteria at Temple Street and Cappagh are so high that it mandates further inquiry. The audit author, UK paediatric orthopaedic surgeon Mr Simon Thomas, also found that while there is worldwide variability between surgeons, the variance identified here cannot be accounted for by measurement error or observer variability alone. Asked about this on RTÉ Radio today, Dr Colm Henry, the Chief Clinical Officer, said the surgeons believed the interventions were necessary and had evolved based on research. Bernard Gloster, the HSE Chief Executive, described the variance as being of very serious concern and said measures will be taken to ensure this kind of variation cannot recur. Minister for Health Jennifer Carroll MacNeill said she is moving now to strengthen governance and oversight structures at Children's Health Ireland and Cappagh. She said this will be done with the appointment of two members of the HSE Board to the Board of CHI. Lawyers representing some of the families said the report makes for difficult reading and that the percentage of affected children is very high. They want speedy access to orthopaedic surgeon reviews and to establish what remedies are needed.
Dublin Live
23-05-2025
- Health
- Dublin Live
Dozens of children may have undergone unnecessary hip surgeries, says new report
Our community members are treated to special offers, promotions and adverts from us and our partners. You can check out at any time. More info 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." Join our Dublin Live breaking news service on WhatsApp. Click this link to receive your daily dose of Dublin Live content. We also treat our community members to special offers, promotions, and adverts from us and our partners. If you don't like our community, you can check out any time you like. If you're curious, you can read our Privacy Notice. For all the latest news from Dublin and surrounding areas visit our homepage.
Irish Times
23-05-2025
- Health
- Irish Times
Hip surgery audit: Almost 70% of operations in two children's hospitals ‘unnecessary'
Almost 500 children who underwent hip operations in two hospitals should be recalled, as close to 70 per cent of surgeries were not necessary, an independent audit has found. Furthermore, one child who received surgery for developmental dysplasia of the hip (DDH), despite not meeting the criteria for the procedure, experienced an 'adverse outcome' from the operation. In July 2024, Children's Health Ireland (CHI) and the National Orthopaedic Hospital Cappagh (NOHC) announced a joint clinical audit to examine a random and anonymised sample of 147 DDH surgeries performed between 2021 and 2023. The audit was prompted following a protected disclosure, which raised concerns that CHI at Crumlin, CHI at Temple Street and NOHC may have used differing criteria to determine whether DDH surgery was required. READ MORE According to the findings of the audit, published on Friday, 85 surgeries performed at Temple Street Hospital (TSH) were examined, of which 51 did not meet the clinical criteria for surgery - meaning 60 per cent were unnecessary. In NOHC, 70 surgeries were audited, and 55 did not meet the criteria - meaning 79 per cent were unnecessary. Only one of the 63 surgeries examined at Crumlin hospital did not meet the clinical criteria. The clinical audit was conducted by Simon Thomas, a UK paediatric consultant orthopaedic surgeon. Children who were included in the audit were over the age of one but less than seven. It examined 147 cases at the three hospitals, involving 14 surgeons. In his report, the auditor notes that it 'is accepted that there is variation on the thresholds' at which different surgeons will recommend the surgery, called pelvic osteotomy. However, he adds the variance identified between Crumlin hospital and the other two 'cannot be accounted for by measurement error or observer variability alone'. The percentages of these procedures not reaching the criteria at Temple Street and NOHC being 'so high mandates further inquiry', the report said. Mr Thomas said surgeons in Temple Street and Cappagh would 'benefit' from peer review across all three sites in relation to decision-making to agree and confirm reasonable clinical and radiological indications. 'This should be a routine part of surgical planning going forward,' he said. The HSE said this has been implemented. The report also recommended that all 497 patients who underwent this surgery at Temple Street and NOHC between 2021 and 2023 should be recalled. 'They should undergo a standardised independent clinical review and radiological assessment. X-rays should then be reviewed, with the history obtained, by appropriately experienced paediatric orthopaedic surgeons from a different institution to NOHC or TSH,' the report said. 'Follow-up with a suitably experienced and independent paediatric orthopaedic surgeon may be required in some cases.' Furthermore, the HSE confirmed a plan has been developed to ensure some 1,800 children and young people who have had the surgery in the two facilities since 2010 will be reviewed up to skeletal maturity. Bernard Gloster, chief executive of the Health Service Executive (HSE) said there is 'little doubt' the findings of the audit 'raise significant concern'. '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,' he said. Lucy Nugent, chief executive of CHI, said the health group 'fully accepts the findings and recommendations from this audit'. 'I am sorry that impacted families were not offered one consistent and excellent standard of care across our DDH service,' she said. 'To one family in particular, whose child experienced complications during their care in Children's Health Ireland, I extend my heartfelt apology that we have let you down.' Ms Nugent said they are 'standardising care' across all CHI sites so all children receive the same high-quality treatment. 'Also, it is important that we now act swiftly to review DDH surgery patients to enable us to answer outstanding questions raised by this audit. This will be done openly and transparently,' she added. Angela Lee, chief executive of NOHC, apologised for the 'distress' the report may cause to children and parents. Minister for Health Jennifer Carroll MacNeill said she 'immediately accepted the recommendations of the report and ensured that others did too'. 'Further to this, I have moved immediately to strengthen governance and oversight structures at CHI and NOHC,' she said. 'This will be done via the appointment of two members of the Health Service Executive Board to the Board of CHI.' CHI and Cappagh Hospital have established a dedicated helpline for patients and families: 1800 807 050, or 00 353 1 240 8706 from outside Ireland. The phone line is open Monday to Friday 8am to 8pm and Saturday and Sunday 9am to 5pm.
Irish Daily Mirror
23-05-2025
- Health
- Irish Daily Mirror
Dozens of hip surgery children did not meet expert's criteria for procedure
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 Cappagha and Temple Street between 2021 and 2023 now require ongoing follow-up to skeletal maturity. 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.'
