Delay in diagnosis: Developmental dysplasia of the hip | Medical Negligence and Personal Injury Blog | Kingsley Napley

by HealthMatters June 12, 2024, 8:29 pm 1.7k Views

Developmental Dysplasia of the Hip (DDH) is a relatively common condition. It tends to affect more girls than boys.

In some babies and young children, the “ball and socket” joint of the hip does not properly form. It is important to diagnose and treat the condition early to reduce the chances that surgery will be required and to increase the likelihood of normal development. In the absence of early treatment, DDH can lead to problems with mobility, pain and osteoarthritis of the hip and back. Children may go on to require hip replacements in adulthood that could otherwise have been avoided or only required later in life.

A missed case of DDH can mean that surgery is required, and a child may be left with a lifelong disability.

Diagnosing DDH

UK guidelines set out that babies should have their hips examined as part of a physical assessment within 72 hours of being born. Tests include the ‘Ortolani’ and ‘Barlow’ tests which are physical manoeuvres to reveal any problems. The Ortolani test identifies a dislocated hip that can be ‘clicked’ back into the socket. The Barlow test identifies a loose hip that can be pushed out of the socket.

If there is an abnormality or there are certain risk factors present, such as a first-degree family history of early life hip problems or breech presentation at birth, then an ultrasound should be requested. Otherwise, babies are re-examined at 6 – 8 weeks, usually by their GP as part of a wider health check.

According to a recent article published in the British Medical Journal (‘Developmental dysplasia of the hip in infants and children’ by Nicholson, Dunne, Taaffe, Sheikh and Murphy), more than two thirds of newborns with DDH do not have any known risk factors and therefore a physical examination is relied upon for diagnosis. However, this could mean that the condition is missed since examination alone is said to have limited diagnostic accuracy.

The article also explains that research suggests the Bartoli and Ortolani tests are more accurate in the first few days of life compared to the 6 – 8 week stage. Further, the reliability of examination is improved when performed by experienced staff, but even experienced professionals miss cases. In the UK, DDH is one of the main causes for claims of negligence against paediatricians and doctors working in general practice.

Once a child is older than three months, the Bartoli and Ortolani tests are said to be of limited value. Signs that indicate DDH in older infants can include limited hip abduction and leg length discrepancy. A parent or teacher may identify an abnormal gait in a toddler, and this should trigger further medical investigations.

Treatment

Where an early diagnosis is made, treatment is usually by way of a Pavlik harness, which is a fabric splint that secures a baby’s hips in a stable position. Late diagnosis often means that the harness cannot be used, and surgery is required, known as surgical reduction, whereby the femoral head (the ball) is placed back into the hip socket. Surgery does not always mean that problems will be fully resolved, and late diagnosis is associated with a significant rate of premature degenerative hip joint disease in early adulthood.

Compensation for delayed diagnosis of DDH

If there is a delay in diagnosis of DDH, and this is found to have been as a result of negligence, then compensation can be claimed for the impact of the delay and may include the costs of private surgery and care in the future, as assessed likely to be needed by independent experts.

Bringing a medical negligence claim for your child can be difficult and stressful. However, the Kingsley Napley team provide clients with a very high level of support through the process and have long standing experience and expertise when it comes to the law and medicine in this area.

There is more information on our hip dysplasia webpage.