CHI Hip Dysplasia Review: What Affected Families Need to Know

A comprehensive examination into paediatric orthopaedic practices across Dublin hospitals has raised critical questions for hundreds of Irish families whose children underwent major hip surgery. Developmental dysplasia of the hip is a condition where a child’s ball-and-socket joint fails to form correctly, ranging in severity from mild instability that resolves spontaneously to complex deformities requiring surgical intervention. A pelvic osteotomy is an invasive, major surgical procedure involving the cutting and realignment of pelvic bones to stabilise the joint. Clinical best practice dictates that such invasive surgery must be justified by rigorous clinical assessments and unambiguous radiographic evidence. However, serious concerns over inconsistent surgical thresholds within Children’s Health Ireland have prompted extensive institutional audits and an international review of historical procedures.

The controversy emerged in 2024 following a protected disclosure by a healthcare professional, which alleged that CHI at Temple Street, CHI at Crumlin, and the National Orthopaedic Hospital Cappagh were operating under sharply divergent surgical criteria. A subsequent independent clinical audit conducted by Mr Simon Thomas, consultant paediatric orthopaedic surgeon at Bristol Royal Hospital for Children, confirmed significant discrepancies across Dublin centres. Published in May 2025, the audit examined a representative sample of 147 surgeries performed between 2021 and 2023 by 14 surgeons. The findings revealed that surgeons at Temple Street and Cappagh operated with a lower threshold for intervention in approximately 60 per cent and 80 per cent of reviewed cases respectively. Crucially, while CHI Crumlin consistently adhered to recognised international standards, several procedures at Temple Street and Cappagh utilised a novel surgical technique that resulted in preventable complications for at least one child in the sample.

The Scope of the HSE External Review

In response to the audit’s findings, the Health Service Executive initiated a broad retrospective review encompassing approximately 1,800 paediatric pelvic osteotomy procedures carried out at Temple Street and Cappagh Kids between January 2010 and March 2025. Patients treated exclusively at CHI Crumlin were excluded from this process, as their care adhered to standard clinical benchmarks. To assess the physical wellbeing of affected patients, CHI established multidisciplinary review clinics providing comprehensive clinical consultations, physiotherapy assessments, and updated imaging where required. By March 2026, more than 1,500 children had been evaluated through these clinical check-ups, which focused strictly on current physical development rather than determining whether the original operations were clinically indicated.

The retrospective evaluation of surgical decision-making has been assigned to an independent international External Expert Panel chaired by Dr Kishore Mulpuri of British Columbia Children’s Hospital in Vancouver. Working entirely from anonymised medical records and pre-operative imaging without physically examining the patients, this panel is charged with determining whether each historic recommendation to operate was clinically justified. The complex process is projected to take at least 12 months, with individual findings to be communicated directly to families alongside a comprehensive systemic report. In tandem with this historical review, CHI has instituted mandatory cross-site multidisciplinary team meetings, ensuring that every child proposed for hip surgery is evaluated by a broad panel of specialists before any procedure is scheduled.

Legal Time Limits and the Statute of Limitations

The existence of an administrative review panel does not alter the formal legal rights of affected children or their parents. Unlike typical personal injury claims arising from road traffic collisions or workplace accidents, actions alleging clinical negligence in Ireland are exempt from the standard assessment procedures of the Injuries Resolution Board. Instead, proceedings concerning alleged medical misdiagnosis or unnecessary surgery must be initiated directly through the Court Service, generally in the High Court due to the severe and long-term implications of paediatric orthopaedic injuries. Because the HSE review is a healthcare governance initiative rather than a judicial tribunal, participation in the process does not toll or pause the statutory time limits that govern medical negligence actions.

Under the Statute of Limitations (Amendment) Act 1991, the traditional two-year limitation period for an injured minor does not commence until they reach the age of majority on their 18th birthday, affording them until age 20 to initiate proceedings. However, because the current review investigates surgeries dating back to 2010, several patients have already reached adulthood, meaning their limitation clock may already be active depending on their specific date of knowledge. The date of knowledge is defined as the point when an individual first became aware that an injury was significant and attributable to potential negligence. Furthermore, parents may possess distinct legal causes of action for independent psychological trauma or direct financial losses incurred while caring for their child, both of which are subject to independent limitation schedules.

Practical Steps and Medical Records Preservation

For parents navigating the uncertainty surrounding their child’s treatment, preserving a comprehensive paper trail is an essential protective measure. Families should formally request their child’s entire medical chart from Temple Street, Cappagh, or any involved private hospital under data protection legislation and Freedom of Information rules. This file should contain original clinical referral letters, contemporaneous consent forms, surgical theatre logs, and full pre- and post-operative imaging archives. Additionally, families should keep records of any findings issued by the multidisciplinary review clinics, alongside detailed documentation of ongoing symptoms, mobility issues, school absences, and rehabilitation therapies. Maintaining records of financial expenditures, such as travel costs, specialised medical equipment, and parental leave from employment, is equally vital should financial recovery become necessary.

Families are also entitled to open disclosure regarding adverse clinical events under the provisions of the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 and the Civil Liability (Amendment) Act 2017. Parents who permitted these surgeries often experience considerable distress, but it is important to recognise that they acted entirely in good faith based on professional clinical guidance provided at the time. Engaging legal representation or seeking an independent opinion does not compromise a child’s ongoing clinical care within CHI or preclude them from receiving panel findings. Given that paediatric skeletal maturity is not achieved until late adolescence, families must ensure their children remain under careful orthopaedic observation while obtaining independent clarity on their legal rights.