Children’s Health Ireland and National Orthopaedic Hospital Cappagh Joint Statement

• The full report can be found on Children's Health Ireland (CHI) and National Orthopaedic Hospital Cappagh (NOHC) websites: here
• Medical information about Developmental Dysplasia of the Hip (DDH) can be found on www.childrenshealthireland.ie/DDH.
• DDH Parent Information Line open: Freephone 1800 807 050 (or call 00 353 1 240 8706 from outside Ireland). Open Monday to Friday 8am to 8pm and Saturday and Sunday 9am to 5pm.
• FAQ on this audit can be found here

Today, Friday 23rd May 2025, Children’s Health Ireland (CHI) has published the findings of the Independent External Medical Audit into the clinical thresholds for performing pelvic osteotomy surgeries in children with Developmental Dysplasia of the Hip (DDH).

Background

In July 2024, CHI and NOHC confirmed they would undertake a joint clinical audit to examine a random and anonymised sample of 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. The clinical audit was conducted by a UK paediatric consultant orthopaedic with specialist expertise in this area, and is now complete.

Audit Findings

The audit reviewed 147 random and anonymous cases across the three hospitals. Based on criteria that had been retrospectively applied for the purpose of the audit, it found:

• Thresholds for recommending pelvic osteotomy procedures did vary between CHI at Crumlin, CHI at Temple Street and The National Orthopaedic Hospital in Cappagh. Based on the criteria that had been retrospectively applied for the purpose of the audit, the auditor raised concerns about the indications for surgery in many cases in CHI at Temple Street and NOHC.

This group of patients will be contacted directly to explain what this means and the next steps for them.

• Children who had surgery at CHI at Crumlin were found to have been appropriately selected for surgery based on the current international standards used by the auditor.
• Regrettably the audit identified one case from the review sample where a child experienced complications due to the surgical approach recommended to them. This family has been contacted and supported through an open disclosure process.

Audit Recommendations

The auditor makes a number of recommendations, which are fully accepted and will be implemented across CHI and NOHC:

Skeletal Maturity*:

We will continue the process of providing follow-up care for all children across the three hospitals who have had any type of hip surgery for dysplasia until the child reaches skeletal maturity. Most patients are already in a follow-up process, but for families who are not yet, you will receive an appointment letter.

CHI at Crumlin:

Children who had surgery in CHI at Crumlin were found to have been appropriately selected for surgery based on the current standards used by the auditor. Children's Health Ireland will write to these families to confirm this information. These children will then continue in their normal follow up processes, including follow up to skeletal maturity.

CHI at Temple Steet and NOHC:

Independent Panel Review: 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 NOHC (from 2021) to establish whether the criteria for surgery align with acceptable parameters as determined by the expert panel. Families will be involved throughout this process.

Standardised Approach: Surgeons across all sites will work together and make decisions using shared, evidence-based criteria. External experts have been appointed to guide this work, and cross-site multidisciplinary meetings are in place.

Family Engagement: Any complications identified during the follow-up reviews will be acknowledged, discussed with families, and appropriate action will be taken. Families will be involved in a thorough and transparent discussion of decision making, including risks and benefits, in order to make informed decisions for their child.

CEO of Children's Health Ireland, Lucy Nugent, said:

“The care and wellbeing of children is our absolute priority in Children's Health Ireland, and I am sorry that impacted families were not offered one consistent and excellent standard of care across our DDH service. I do not underestimate the stress and anxiety that families are rightfully feeling throughout this audit process. 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. I would like to give my assurance to all of the families affected, that they will be directly supported and are being contacted with follow up information and the next steps.

“We are currently standardising care across all CHI sites, so all children receive the same high-quality treatment no matter where they are seen. 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”.

“I wish to thank the external auditor for his time and expert consideration throughout this audit process. Children's Health Ireland fully accepts the findings and recommendations from this audit. I am working closely with our Board and colleagues in CHI to implement the recommendations, with the support of the HSE and DoH."

CEO of National Orthopaedic Hospital Cappagh, Angela Lee, said:

“The National Orthopaedic Hospital Cappagh apologises for the distress that today’s published report may understandably cause to children who have had surgery in NOHC and to their parents. In recent years, Cappagh has worked with Children’s Health Ireland to improve children's access to planned paediatric orthopaedic surgery. We are committed to implementing the audit recommendations. Some changes are already underway, with others planned and we will be communicating with all parents/guardians accordingly in the coming days.”

Information for families:

• Frequently asked questions are answered for families on Children's Health Ireland’s website: FAQ
• The DDH Parent Information Line is open for families who have queries following this audit’s publication:

Freephone 1800 807 050 (or call 00 353 1 240 8706 from outside Ireland).

Open Monday to Friday 8am to 8pm and Saturday and Sunday 9am to 5pm.

• If you have clinical concerns about your child, please contact your GP or medical team directly.

CHI and NOHC will write to parents and their families to ensure that all affected are kept informed as appropriate as we progress to the next stage of this process.

CHI and NOHC recognise that this is a concerning time for patients and their families. We are committed to making every effort to support families during this process.