What has happened?
Investigation into Hip Surgeries (Developmental Dysplasia of the Hip)
A major independent audit was published in May 2025 regarding hip surgeries performed to treat Developmental Dysplasia of the Hip (DDH).
This audit forms a key part of ongoing scrutiny into unnecessary hip surgeries in Ireland.
The findings
The audit revealed that a significant number of surgeries performed between 2021 and 2023 at Temple Street Children’s Hospital and the National Orthopaedic Hospital, Cappagh, did not meet the standard clinical criteria for intervention.
These findings have contributed to wider concerns about unnecessary hip surgeries.
- Children’s Health Ireland (CHI) at Temple Street: Approximately 60% of the reviewed cases did not meet the threshold for surgery.
- National Orthopaedic Hospital Cappagh (NOHC): Nearly 80% of the reviewed cases did not meet the threshold.
- Children’s Health Ireland (CHI) at Crumlin: In contrast, surgeries here were largely appropriate (98% met the criteria).
These figures have been central to public discussion of unnecessary hip surgeries performed during this period.
The Issue
The audit suggests that many children underwent “unnecessary” invasive surgery, potentially exposing them to avoidable pain, long recovery times, and surgical risks.
The issue of unnecessary hip surgeries has therefore raised significant clinical and governance concerns.
Recall of patients
As a result, approximately 500 children who had pelvic osteotomy surgeries at these hospitals between 2021 and 2023 are being recalled for independent clinical review and radiological assessment.
This recall process relates directly to the review of unnecessary hip surgeries.
Wider review (2026)
In November 2025, the HSE confirmed that an External Expert Panel (EEP) will review surgical decisions dating back to January 2010.
This massive review is scheduled to begin no later than January 2026 and is expected to take at least 12 months to complete.
The wider review will further examine the extent of unnecessary hip surgeries over time.
Major review of Hip Dysplasia surgeries nears completion but many children will be excluded
A long-awaited expert review panel examining thousands of children who underwent hip dysplasia surgery in Ireland is close to being finalised.
However, it has emerged that a significant number of children, including those who had operations performed at Crumlin Hospital, will not be included in the process.
This development remains relevant for families affected by unnecessary hip surgeries.
The HSE confirmed that Dr Kishore Mulpuri, a globally recognised expert in DDH and Chair of Orthopaedics at the University of British Columbia, will chair the External Expert Panel (EEP), which is being established in response to concerns raised in the Thomas Report, an independent audit carried out earlier this year.
The panel’s work will address clinical decision-making related to unnecessary hip surgeries.
Dr. Mulpuri is known for
• Leading international DDH clinical guidelines
• Directing the International Hip Dysplasia Institute’s research programmes
• Managing major global registries across five continents
Background: Audit highlights major variations across hospitals
The UK surgeon Simon Thomas reviewed 147 surgeries performed between 2021 and 2023 at Temple Street, Crumlin, and Cappagh hospitals after a whistleblower revealed inconsistencies in the criteria used to recommend surgery for developmental hip dysplasia (DDH).
These inconsistencies have been cited in discussions concerning unnecessary hip surgeries.
- Temple Street and Cappagh: A high proportion of surgeries appeared to fall below international thresholds for intervention, raising further concerns about unnecessary hip surgeries.
- Crumlin Hospital: Only one of 63 surgeries was found to fall short of clinical criteria.
Based on these findings, the HSE clinical lead for quality and patient safety, Orla Healy, stated that children who had surgery in Crumlin are “out of scope” for the upcoming review.
Who will be included in the new review?
The EEP will examine an estimated 2,000 surgeries performed between 2010 and 2024. However, the scope is tightly defined. This examination forms part of the broader response to unnecessary hip surgeries.
Included:
- Children who had pelvic osteotomy for developmental hip dysplasia in otherwise typically developing hips.
- Surgeries from Temple Street and Cappagh.
Explicitly excluded:
- Children who had surgery in Crumlin Hospital.
- Children with acquired hip dysplasia are linked to conditions such as:
- Cerebral palsy
- Spina bifida
- Other neuromuscular or complex medical needs
How the review will work
The EEP will review only the original decision-making behind children’s surgeries. It will examine:
- Medical records
- X-rays
- Ultrasound images
- Other radiology reports
It does not involve clinic visits or physical examinations. This review process is intended to assess whether unnecessary hip surgeries occurred.
Timeline
Review work begins: No later than January 2026
Expected duration: At least 12 months due to the large volume of cases
Outcome:
- Every child will receive an individualised report.
- A public overall report will be published on the HSE website.
These outcomes are expected to provide clarity regarding unnecessary hip surgeries.
Clinical review and mental-health supports
Separate from the EEP, CHI and Cappagh are conducting clinical reviews for patients currently under their care.
The HSE has also established dedicated mental-health supports for families affected by unnecessary hip surgeries:
- Freephone: 1800 807 050
- International callers: +353 1 240 8706
These services are available to any parent, guardian, or young person affected by the surgeries or the ongoing review of unnecessary hip surgeries.
Government continues oversight
Health Minister Jennifer Carroll MacNeill said she has instructed both CHI and the HSE to provide consistent, open communication with families.
She acknowledged the high levels of anxiety and uncertainty among parents impacted by concerns relating to unnecessary hip surgeries.
The Minister also confirmed continued engagement with the Hip Dysplasia Advocacy Group, which has been actively involved in oversight and transparency regarding unnecessary hip surgeries.
A process under intense scrutiny
As the External Expert Panel moves toward finalisation, families continue to seek clarity, reassurance, and answers. With thousands of children affected and concerns still emerging, pressure remains on the HSE and CHI to ensure a process that is:
- Independent
- Transparent
- Clinically robust
- Compassionate toward families
The coming months will be critical in restoring trust and understanding the full scope of what happened over more than a decade of hip dysplasia surgeries, including the review of unnecessary hip surgeries.
Summary of key developments
- A major independent audit published in May 2025 examined hip surgeries performed for Developmental Dysplasia of the Hip (DDH) and is part of ongoing scrutiny into unnecessary hip surgeries in Ireland.
- The audit found that a significant number of surgeries carried out between 2021 and 2023 at Temple Street Children’s Hospital and the National Orthopaedic Hospital, Cappagh, did not meet standard clinical thresholds, contributing to public concern about unnecessary hip surgeries.
- Approximately 60% of reviewed cases at Temple Street and nearly 80% at Cappagh did not meet the threshold for surgery, while surgeries at Crumlin Hospital were largely appropriate, with 98% meeting the criteria.
- The findings suggest that some children may have undergone unnecessary invasive surgery, exposing them to avoidable pain, prolonged recovery, and surgical risks, raising clinical and governance concerns about unnecessary hip surgeries.
- As a result, around 500 children who underwent pelvic osteotomy surgeries between 2021 and 2023 are being recalled for independent clinical and radiological review as part of the response to unnecessary hip surgeries.
- In November 2025, the HSE confirmed that an External Expert Panel (EEP) will review surgical decision-making dating back to January 2010, with the review due to begin no later than January 2026 and expected to take at least 12 months.
- The EEP will be chaired by Dr Kishore Mulpuri, whose work focuses on DDH clinical guidelines and international research, and the panel will examine whether unnecessary hip surgeries occurred based on the original clinical decisions.
- The review will assess approximately 2,000 surgeries carried out between 2010 and 2024, focusing on pelvic osteotomy procedures at Temple Street and Cappagh, while surgeries performed at Crumlin Hospital and cases involving complex or neuromuscular conditions are excluded.
- The EEP will review medical records and imaging only, without clinical examinations, and every child included will receive an individualised report, alongside a public overall report to be published by the HSE.
- In parallel, CHI and Cappagh are conducting clinical reviews of current patients, and the HSE has established mental health supports for families affected by unnecessary hip surgeries.
- Government oversight continues, with the Minister for Health instructing consistent communication with families and ongoing engagement with the Hip Dysplasia Advocacy Group, as the process remains under close scrutiny.
