A Canadian surgeon has been selected to chair the External Expert Panel responsible for the CHI pediatric hip surgery review at Temple Street and Cappagh hospitals.

In November 2025, the Health Service Executive (HSE) announced the appointment of Dr Kishore Mulpuri, an internationally recognised Canadian surgeon, as chair of the External Expert Panel (EEP) investigating pediatric hip surgeries at Children’s Health Ireland (CHI).

This appointment represented a significant advancement in the CHI pediatric hip surgery review process.

The review began in January 2026 and is expected to take at least 12 months to complete.

The findings of the CHI pediatric hip surgery review are anticipated to inform both clinical practice and governance standards within paediatric orthopaedic care in Ireland.

Overview of the Expert Panel and Dr Kishore Mulpuri

Dr Mulpuri is a Consultant Paediatric Orthopaedic Surgeon and Head of the Department of Orthopaedics at the University of British Columbia and British Columbia Children’s Hospital.

He was selected due to his international experience in managing Developmental Dysplasia of the Hip (DDH), a condition central to the CHI pediatric hip surgery review.

• Role: The panel is tasked with conducting a comprehensive review of medical records and radiological images through a paper-based methodology as part of the CHI pediatric hip surgery review.
• Anonymity: To ensure objectivity and protect patient privacy, all patient identities are coded and withheld from panel members.
• No Physical Examinations: The panel will assess original clinical and surgical decisions without carrying out new physical examinations, a standard approach within the CHI pediatric hip surgery review framework.

Background and Rationale for the Investigation

The External Expert Panel was convened following a high-profile audit by UK-based orthopaedic surgeon Dr. Simon Thomas, published in May 2025.

That audit raised significant concerns about the volume and clinical justification of certain procedures, which were later examined in the CHI pediatric hip surgery review.

Key findings from the audit included:

• Temple Street and Cappagh: Approximately 70% of reviewed surgeries at CHI Temple Street and the National Orthopaedic Hospital, Cappagh, did not meet internationally accepted surgical thresholds.
• Crumlin: In contrast, almost all surgeries at CHI Crumlin were assessed as appropriate.

Review objective: The CHI pediatric hip surgery review aims to determine whether large numbers of children underwent invasive pelvic osteotomy procedures that may not have been clinically indicated.

Current status as of January 2026

Scope: The CHI pediatric hip surgery review examines surgeries dating back to 2010 at Temple Street and from 2021 at Cappagh.

• Recall process: In addition to the expert review, a parallel “one-stop” clinical review is underway. By late 2025, over 600 children had already attended MDT clinics to assess current health outcomes linked to the CHI pediatric hip surgery review.
• New safeguards: Since March 2025, no child within the CHI system has undergone hip surgery without prior discussion at a cross-site MDT meeting, a procedural change informed by early findings of the CHI pediatric hip surgery review.

The panel’s final report is expected in early 2027 and is likely to clarify for families whether surgical intervention was clinically necessary.

1. Clinical criteria: defining the threshold for surgery

A central issue examined in the CHI pediatric hip surgery review is the Acetabular Index (AI), a radiological measurement used to assess hip development.

• International standard: Surgery is generally considered only when the AI exceeds two standard deviations from the mean.
• Audit findings: The Simon Thomas audit identified cases where surgery proceeded at substantially lower thresholds, including borderline measurements or non-specific clinical signs.
• Review goal: The CHI pediatric hip surgery review will apply internationally recognised Z-scores to determine whether non-surgical management would have been appropriate in specific cases.

2. Legal Implications for Families

Legal experts in Ireland have identified several avenues for families who feel their children were subjected to unnecessary procedures:

• Medical Negligence Claims: If the expert panel confirms a surgery did not meet clinical thresholds, families may have grounds to sue for “battery” (operating without a valid medical reason) or negligence. This covers:
• Pain and Suffering: The physical trauma of the surgery and recovery.
• Loss of Opportunity: The risk that unnecessary surgery causes scar tissue or complications that make future, legitimate treatments more difficult.
• Psychological Impact: For both the child and parents.
• Informed Consent Issues: A key legal pillar is whether parents were told that non-surgical options were viable. If a surgeon presented surgery as the only option when international guidelines suggested “watchful waiting,” the consent may be legally invalid.
• Statute of Limitations: Although there is typically a two-year period to file a claim, for minors, the limitation period often commences upon reaching the age of 18. Additionally, the date of knowledge, defined as the date on which the parent first became aware that the surgery may have been unnecessary, is a critical legal consideration.

3. Practical Guidance for Parents (2026)

For individuals representing families or those directly affected, current recommendations from patient advocates and legal counsel include the following: