Acetabular Revision for Congenital Hip Dysplasia
Congenital hip dysplasia, or developmental dysplasia of the hip (DDH), must be diagnosed within the first few weeks of a child's life. If there is a delay in diagnosis and treatment, it can lead to severe hip problems in later life.
What is congenital hip dysplasia?
Congenital hip dysplasia is known medically as developmental dysplasia of the hip (DDH). It is when the hip joint does not develop normally in babies or young children, making the hip joint very loose and prone to dislocation.
How is congenital hip dysplasia diagnosed?
Hip dysplasia is diagnosed in newborn babies with routine screening tests, the first of which should occur within 72 hours of the birth. The second test will happen when the baby is between six and eight weeks old.
A common test used to diagnose DDH is the Ortolani Barlow test. This involves flexing the baby's hips to see if they click. However, this test must be carried out within the first eight weeks of the child's life. After this the test will not be effective in diagnosing the condition.
Treating DDH
Is DDH is discovered in a newborn baby, their hips will need to be secured with a special harness called a Pavlik harness. This must remain in place for a matter of weeks and will keeps the hips in the correct position while the baby develops.
Can congenital hip dysplasia be missed?
Screening tests for developmental dysplasia of the hip (DDH) by clinical examination are not fool proof and the problem can be missed, although around 70% are picked up. It is also recognised that some hips can be normal at birth but subsequently become abnormal with growth and dislocate when the patient begins to walk. If the problem is bilateral (meaning in both hips) it can be especially hard to detect, because although walking may initially appear odd it would also seem symmetrical and many children have a somewhat abnormal gait which resolves.
What happens if hip dysplasia is missed?
If hip dysplasia is missed, the child will have difficulty crawling and walking. Their leg may drag along the floor and there may be a marked limp when the start to walk. Surgery will then be needed to fix the dysplasia.
Nevertheless, if this is delayed for too long the hip can be significantly deformed and the problem can be difficult to rectify. Consequently multiple operations may be needed throughout the person's lifetime. Even with such treatment, he/she may remain severely disabled by their condition.
Is there a claim for negligence?
Hip dysplasia in children can be missed. Whether this amounts to negligence or not depends on whether the appropriate assessments were made. These tests cannot be said to be fool proof, so if they were performed but the condition was missed, it may not amount to negligence. But if the tests were not carried out at all, causing the condition to go undiagnosed and untreated, there could be a case to be pursued.
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