Dr. Joan Gilvarry:

Since we were before the committee this time last year, we have a lot more information on the issue. However, we do not yet have a clear answer; it is multifactorial. We are coming closer to an answer and it has to do with the size of the head of the femur and the shallowness of the cup into which it goes. However, it is also very much dependent on the patient's condition, patient selection and the technique of the surgeon. Surgeons tell us that with metal on metal, there is contrition and that they must get it perfect when inserting the hip, whereas the older process allowed for some contrition. It, therefore, has to do with patient selection and the implantation technique used, but the need for post-operative follow-up and rehabilitation also come into play. With biomechanical design, we are coming closer to the issue being the size of the head of the femur and the shallowness of the cup into which it goes. Mr. O'Mahony referred to the SCENIHR report. The expert committee in Europe has reviewed the situation in the past year; we contributed to the review and expect its outcome to be published within the next couple of days. I think it will reflect what I have said, that the cause is multifactorial, but it is mainly due to the size of the femur head.

With regard to the need for follow-up, we tried to get current numbers from the HSE. We know that some 350 people underwent revision surgery about this time last year and that another 166 were lined up to have the procedure done. In recent discussions with the HSE it told us it had reviewed every patient. I am aware that the revision surgery is carried out free of charge, but I do not know whether the patients have been compensated. However, I am aware that there are ongoing legal proceedings in that regard.