Congenital Hip Dysplasia/Dislocation
At Bolt Burdon Kemp, we have many years’ experience acting for children affected by the delayed diagnosis of congenital hip dislocation or hip dysplasia. You may also have heard this described as developmental dysplasia of the hip or “DDH”. It tends to be more common in girls and firstborn children.
However it is described, this condition arises when the ‘ball and socket’ joint of a baby’s hip does not form correctly. This means that the cup-shaped hip socket is too shallow for the rounded edge of the thigh bone to sit in it securely. This results in either the hip joint being loose or, in more severe cases, the thigh bone dislocating.
Provided this problem is identified early on in a child’s life, it can usually be corrected quite easily and without any long term impact. It is important to recognise that whilst hip dysplasia is not preventable, its impact will depend on when it is diagnosed and subsequently treated.
When investigating whether there have been errors in failing to diagnose hip dysplasia or dislocation, it is often necessary to consider the child’s hospital and GP records to understand whether the appropriate medical examinations took place at all and if they did, whether they were done to an acceptable standard.
After a baby is born, a series of examinations will take place within the first 6 weeks or so. These examinations will include tests and observations of the baby’s hips.
The first check tends to be undertaken by the delivering midwife just after the baby is born. However, this would not extend to the checking of the baby’s hip stability. The next test is called the Neonatal and Infant Physical Examination or NIPE and that must be carried out no earlier than 4-6 hours of birth but no later than 72 hours. This screening will be done by a midwife or doctor who will have the necessary qualification and will include an assessment of the baby’s hip joints, amongst other things. Where concerns exist as to the stability of the hip, the baby should then have an ultra-sound.
Thereafter, the NIPE will then be repeated at the baby’s 6-8 week check-up – usually by a GP. The rationale is that it can sometimes be difficult to identify all congenital (meaning ‘present from birth’) abnormalities within the first 72 hours of birth.
Hip dysplasia is sometimes described as a ‘silent condition’ because it won’t always cause pain in babies and infants. This can mean its diagnosis may be delayed if the initial examinations don’t spot the problem.
Some of the most common signs that parents can look out for in the child include:-
- Asymmetry in the child’s buttocks or groin creases (perhaps where one crease sits lower than the other);
- Hip clicking;
- Difficulty in parting the legs for nappy changes; and
- Limited range of motion or a limp can be suggestive of a leg length discrepancy
Provided the condition is picked up early, treatment in most infants is not invasive and the child will go on to develop normally and with a full range of movement in their hip. Treatments can range from the fitting of soft positioning devices or braces worn until the hip has been repositioned, to more intrusive surgery.
The longer the delay in diagnosis, the more invasive the likely treatments to put it right tend to be. This might include either a ‘closed’ reduction whereby the child’s hip is manoeuvred under anaesthetic by a doctor and into the correct position or, in more severe cases, open surgery whereby a surgeon will move the misplaced femoral head back into the hip socket.
Where treatment is delayed, longer term problems can develop including:-
- A limp;
- Hip pain;
- Stiff joints or even osteoarthritis
What to do if you suspect delayed diagnosis
At Bolt Burdon Kemp we have experience in investigating whether there has been a negligent delayed diagnosis of hip dysplasia and if so, ensuring compensation is secured.
Particularly in longer term delays, the consequences for the child (and his/her parents) can be very significant including arthritis, pain and potentially the prospect of early hip replacements. Oftentimes, it can be necessary to delay the settlement of these claims because the full longer term consequences won’t become known until the child is much older, sometimes not until they reach their teenage years.
In these circumstances, it may be possible to recover compensation for losses which have been suffered and to cover the cost of treatment which might be required in the future. It is therefore important that when you suspect a delayed diagnosis, you consult with specialist medical negligence solicitors with the appropriate experience of these complex claims.