Medical negligence and congenital hip dislocation

Congenital hip dysplasia (CDH), also known as developmental dysplasia of the hip (DDH) is a condition some babies are born with where the hip joint fails to develop properly. If untreated, hip dysplasia can lead to long-term complications. Treatment depends on the severity of hip dysplasia, with mild cases possibly being capable of resolving independently and more severe cases requiring time in a Pavlik harness, casting or surgery. Early diagnosis and treatment are therefore crucial to the long-term outcome for your baby.

• Medical negligence claims - congenital hip dislocation 
• What is congenital hip dysplasia?
• What causes congenital hip dislocation?
• Signs and symptoms of congenital hip dislocation
• Treatment for congenital hip dislocation
• Congenital hip dislocation terminology

Medical negligence claims - congenital hip dislocation 

Doctors should be able to diagnose congenital hip dislocation during the new-born examination or the 6-8 week post-natal check. Early diagnosis and proper treatment are important to help the baby recover, develop and enjoy as full a range of movement as possible in their hips. Babies with congenital hip dislocation may need treatment to try and resolve the problem. Failure to detect congenital hip dislocation and start treatment early can lead to long-term health problems. 

Claims for congenital hip dislocation usually arise as a result of:

·       There was a failure to follow protocols or carry out the tests at the relevant time.

• Misdiagnosis by incorrectly interpreting the results of the tests or failing to carry out further tests.
• Delays in referral or treatment once congenital hip dysplasia is suspected.

You might have a claim for negligence if your child:

• suffered unnecessary pain or required avoidable surgical treatment because of the delayed diagnosis
• faces long-term effects of hip dislocation because of the delayed diagnosis, such as: arthritis, difficulty walking and future hip replacement surgery.

If you are concerned about the standard of care your baby received during diagnosis or treatment of their hip dysplasia, and think this might have caused a problem, talk to our medical negligence claims specialists. We’ll listen to your concerns, and help you find out what happened and why.

What is congenital hip dysplasia?

Congenital hip dysplasia (also called developmental dysplasia of the hip) is an abnormality of the hip joint. It can cause partial or total dislocation of the hip.

The NHS states that long-term effects of untreated congenital hip dislocation may include:

• developing a limp
• painful, stiff joints (osteoarthritis)
• hip pain.

Babies with congenital hip dislocation are born with an unstable hip. This can affect their mobility and range of movement in the hip. Usually, this condition shouldn’t interfere with babies learning to crawl or walk.

Fortunately, congenital hip dislocation is quite rare and treatable. It affects about 1 or 2 out of every 1,000 babies born in the UK.

What causes congenital hip dislocation?

Doctors don’t know precisely what causes congenital hip dislocation, and the NHS advises that it’s not preventable.

However, certain risk factors are linked to an increased chance of a baby being born with congenital hip dislocation. These include:

·        Family History: where there is a family history of hip problems

• Gender: females are more likely to have the condition than males
• Breech Birth: if the baby is born in the breech position (born bottom or feet first)
• Multiple Births: if you are expecting twins or multiple births
• Prematurity: if your baby is born prematurely
• First Baby: if it’s your first baby.

If your baby is at risk of being born with hip dislocation, your doctor/midwife may advise you of this during your antenatal care. However, as there is no way of being sure of this before the baby is born, the doctor or midwife will ensure that your baby’s hips are examined immediately following birth.

Diagnosing congenital hip dislocation

A  prompt diagnosis gives the baby the best chance of recovering and enjoying a normal range of motion in their hips. Babies should be checked for signs of hip dislocation as part of their routine care.

Your baby will be checked early for signs of hip dislocation. Usually, the first check takes place in the hospital, very soon after delivery. A doctor or midwife should check your baby’s hips within 72 hours after birth. This is part of the newborn examination and shouldn’t cause your baby any discomfort. The person performing the test will gently move baby’s hips to check for early signs of hip dislocation, such as hip joint instability. Your healthcare professional should also check how the baby was delivered and ask if hip dislocation runs in your family.

This is a routine examination. It would be negligent of your care providers not to carry out the examination around the time of your baby’s birth. You should be told if there are any abnormal findings. If a problem is identified during the check, you should be advised of the following steps, and action should be taken to make a firm diagnosis and to rectify the problem.

Your baby’s hips should also be checked at the 6 - 8 week post-natal check. This is a standard check to make sure your baby is healthy. It’s another opportunity for doctors to diagnose hip dislocation, which may not have been evident at the time of your baby’s birth. 

If the doctor identifies a possible problem, they may refer your baby for more tests, such as an x-ray or ultrasound scan. 

The checks are in place to diagnose hip dislocation early and start treatment as soon as possible.

Signs and symptoms of congenital hip dislocation

The early checks of a baby’s hips are designed to help ensure early diagnosis of hip dislocation.

However, hip dislocation may be diagnosed later in your child’s development as they may not show obvious signs at their first check-ups. The NHS states that parents should contact their GP if they notice that their baby:

• has restricted movement in one leg or both legs
• has a clicking or popping sound when moving their legs
• has one leg which seems longer than the other
• has uneven skin folds on their buttocks/thighs
• lets one leg drag behind the other when they crawl
• develops a limp, walks on their toes or seems to have an abnormal gait.

Treatment for congenital hip dislocation

Pavlik Harness: A soft brace to correctly hold the baby’s hips while the joint develops.

Casting: In more severe cases, a baby may be placed in a full-body cast (spica cast) to maintain the hip in the correct position.

Surgical Treatments: In cases where non-surgical methods do not work or if the child is older, surgery may be necessary. This can involve realigning the hip joint.

Early diagnosis and intervention significantly improve the prognosis, reducing the likelihood of future mobility issues and the need for more invasive procedures.

Congenital hip dislocation terminology

Below is a helpful glossary of terms you might hear about congenital hip dislocation.

Where appropriate, these terms are explicitly explained in the context of congenital hip dislocation.

• Congenital: a condition that a baby is born with.
• Dysplasia: abnormal development of tissue (such as bones and muscles) or an organ. In the case of congenital hip dysplasia, it means abnormal hip joint growth.
• Dislocation:  an abnormal separation of a joint. Congenital hip dislocation may mean partial or total dislocation of the hip joint.
• Congenital hip dysplasia/dislocation is when the ball of the baby’s femur does not properly sit within the hip socket. The extent of hip dislocations varies.
• Hip Subluxation is when the hip joint is partially, but not fully, dislocated. This happens when the femur ball does not entirely fit within the hip socket.

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