HIP DYSPLASIA - MEDICAL NEGLIGENCE SOLICITORS
Hip dysplasia is a relatively common condition of infants in which the hip joint is abnormal. The problem can be with the acetabulum (hip socket) or with the hip joint (femoral head) or with both. The actual terminology of the disease is developmental dysplasia of the hip or DDH. It used to be called congenital dysplasia of the hip. Whilst hip dysplacia is a naturally occurring phenomena, healthcare professionals should always be on the lookout for it and failure to recognise it early may well cause lifelong permanent problems for a child that can result in a solicitors medical negligence compensation claim.
According to the World Health Organisation the highest incidence of medical negligence in the developed world occurs in Australia. If you have been injured by a healthcare professional including a doctor, dentist, nurse or technician and would like to speak to a medical negligence lawyer without further obligation, just use the helpline. A hip dysplasia medical negligence lawyer who deals exclusively in personal injury claims will speak to you, giving free advice and information on how best to preserve your legal right to receive compensation as a result of injuries caused by medical negligence.
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Hip Dysplasia - Medical Negligence
Developmental hip dysplasia is an abnormality of the infant hip that needs to be treated to prevent complications. Such a thing can affect one hip or both hips. If the condition is mild, the ligaments around the hip joint are loose so that the joint moves more than is acceptable. In cases that are more severe, the ball of the joint subluxes; that is, it comes partway out of the socket of the joint. In very severe cases, the hip joint dislocates completely out of the socket and sometimes returns to the socket with difficulty. In such cases, the hip socket has become too shallow so it doesn't hold the ball very well.
About 1 out of every 7 with DDH and one out of every four are breech babies or have a family history of DDH (Developmental Dysplasia of the Hip).
The exact cause of DDH isn't clear; however there are specific factors to pay attention to. About one in 75 babies who has a risk factor will go on to have a dislocation.
Risk factors of DDH include:
- Having a first degree relative with DDH leads to a five time increased likelihood of having the condition yourself.
- Female gender predisposes one to having hip dysplasia. About 8 out of 10 cases of hip dysplasia are of the female gender. It might be due to estrogen in the system that stretches the ligaments more.
- Oligohydramnios in the pregnancy can lead to an increased risk of hip dysplasia. This is because there is less fluid in the uterus to allow the baby’s hips to grow.
- Babies born in the breech position are more likely to have hip dysplasia. The hips are placed in a certain position so as to be more likely to slip out of position.
- Being a firstborn baby. About six of ten children with DDH occur in firstborn babies. The uterus is tighter in such conditions with less room for the fetus to move.
- Babies with cerebral cord palsy, nerve or muscle disorders, or spinal cord problems have an increased chance of getting hip dysplasia. Preterm babies have a higher risk as well.
- Certain races have a higher risk of hip dysplasia. These include babies born of Chinese and of American Indian families.
Babies with hip dysplasia will have symptoms that include having a hip that loosens or slips out of place when being examined. One leg will seem shorter than the other. There will be extra folds of skin found on the inside of the eye and a hip joint that will move differently when compared to the other. A walking child will walk with the heel of one foot and with the toes of the other. There will be a waddling gait or a limp when walking.
The diagnosis of hip dysplasia is made when doing the infant hip exam. The hip appears to pop out of the socket when the hip is forward flexed and abducted. Older babies will have a limited degree of hip movement in the affected hip. If the physical examination is questionable, an ultrasound or x-ray of the hip can confirm the diagnosis. Ultrasound is considered the preferable test over an x-ray examination.
Hip dysplasia is treated in different ways, depending on age at diagnosis and severity of disease. Some infants, less than age six months, are treated with a Pavlik harness. A hard, spica cast is used in older babies. These things allow immobility of the hip while the hip matures around itself. Surgery or braces can be used in some cases.
It is a good idea to catch the condition as early as possible. Kids caught in the neonatal phase generally do not have long term problems. Children with DDH that are not treated or are treated late can have serious hip problems. It shouldn’t be something you try to take care of on your own. Such treatments can result in the permanent abnormality of the hip. Arthritis of the hip is common and there is chronic plain. Even if the treatment is late, it is better than no treatment at all.
Children treated before the age of six months have a great outcome. They will need to be x-rayed every so often while they grow. If the child had begun to walk before treatment, the prognosis is less than good. About 3 out of every 10 hip replacement surgeries are done in those under age 60 because of a complication of DDH.
Medical Negligence Solicitors
If infant hip dysplasia was worsened or was not diagnosed due to mistakes by a doctor or hospital, it is important that you protect your interests and make certain that you are compensated for injury to yourself or your child. Our medical negligence solicitors normally deal with claims using a no win no fee arrangement which means that if you don't win then you don't pay them their professional costs. If you would like legal advice at no cost then just complete the contact form or email our offices or call the helpline and an infant hip dysplacia solicitor will telephone to discuss your potential claim.
Hip Dysplasia Overview
Infant hip dysplasia is a diagnosis made usually at birth or shortly after birth that involves an abnormality of the infant's hip. The hip is a ball and socket joint that does not always stay tightly within the ball and socket so that a particular maneuver can show a click, meaning the joint is susceptible to dislocation. The problem is also called congenital dysplasia of the hip or CDH. It is now formally known as developmental dysplasia of the hip or DDH.
The cause of hip dysplasia is not known completely. It occurs in about four births out of a thousand or 0.4 percent and is usually seen in girls who are first born. Risk factors for developing infant hip dysplasia include having a family history of hip dysplasia, being born breech or having a relative lack of amniotic fluid within the uterus, a condition called "oligohydramnios". Infants with a club foot or a twisted neck at birth are at higher risk for having hip dysplasia.
Doctors do a particular physical examination to determine if there is hip dysplasia. The knees are drawn up and the hip is rotated outward to feel for a click when this maneuver is done. The tests for hip dysplasia are known as the Barlow test and the Ortolani test. Both maneuvers will cause a hip click to occur at the time of the test if there is congenital hip dysplasia.
Once a hip click is felt, the doctor often does an ultrasound of the hip to see if it dislocates. Because the bones are not very well developed in infants at birth, an x-ray is often not helpful. The ultrasound instead can show the positioning of the ball and socket and can show a socket that is poorly developed or a ball that is out of the socket (dislocated).
The treatment of congenital hip dysplasia depends on how old the child is. The idea is to treat it as soon as possible so that chronic dislocation does not occur. The chances of full recovery are greater with early treatment. If a baby is from birth to six months, a special harness is used to keep the hip within the socket. It is called a Pavlik harness. The baby wears it at all times like a cast to keep the joint stable. If it is not picked up until later, congenital hip dysplasia is treated differently. The baby may need to be knocked out with anesthesia in order to put the hip into place. The hip is put into a special cast called a spica cast that keeps the hip stable for several months. This is done if the baby is between 6 and 12 months of age.
If the baby is older than a year, surgery may be required to put the hip joint in the right position. A spica cast is then used for several months to keep the hip joint in the proper position. The baby will not be able to walk while it is in the spica cast.
The success of the treatment of congenital hip dysplasia depends on how old the child is at the time of treatment of the disease and on how well the hip is able to be reduced. The chances of complete recovery go down with the advancing age of the child at the time the treatment is started. Those who do not do well will develop early hip arthritis and difficulty walking. Such a child may need to have a hip replacement later in life to replace the damaged joint. Congenital hip dysplasia can be a painful disease that can influence the ability of the infant to get around and ambulate properly.
No one knows exactly what causes developmental dysplasia of the hip although there seem to be some predisposing factors. It is more common in girls and is present in 0.4 percent of all births. Other risk factors include having a family history of hip dysplasia, being born under the condition of oligohydramnios or being born in the breech presentation. Club foot or torticollis can be conditions of being seated abnormally in the uterus and hip dysplasia can be a part of this group of symptoms.
Babies are tested for hip dysplasia at birth. Doctors do an exam and feel for a hip click when abducting the hips with the knees in the flexed position. The tests, called the Ortolani and Barlow tests, push the hip out of its normal position and indicate that hip dysplasia is present. If a click is felt, the doctor can do an ultrasound of the hip to check the hip joint out. X-rays do little to determine what is going on in the hip joint because the bones haven’t developed enough to be seen well, especially in the joint regions. The ultrasound can show the ball of the hip out of the socket or a very shallow socket that doesn’t hold the hip joint together. Ultrasounds are used for diagnosis as well as for following the nature of the treatment.
The treatment of hip dysplasia completely depends on the age of the infant. The idea behind treatment is to put the hip joint back in place and allow it to hold there permanently. It is easier to treat a very young child with hip dysplasia than it is to treat an older child. The hip joint becomes more fixed in the socket and eventually it stays there without treatment. From birth to six months of age, hip dysplasia reduces easily and the child wears what is called a Pavlik Harness—a device that keeps the hips in place until the baby recovers fully. Using just the brace, about 90 percent of babies need no further intervention. It is used after birth for several weeks until the hip has recovered.
If the diagnosis of hip dysplasia is not made until after six months of age and up to one year, the Pavlik harness will not work very well. Instead, surgery is done under general anesthesia that puts the hip back in its proper place. After that, a spica cast is placed that holds the hip joint in the proper place. The cast is relatively immobile so that it keeps the hip stable until it heals.
If a child is not diagnosed with hip dysplasia until after one year of age, surgery is required to put the hip back in place. Scar tissue is broken down which otherwise interferes with the joint’s ability to go into proper positioning and stay there.
There needs to be adequate replacement of the hip joint within the hip socket and an adequate means of keeping it there. If the child is young or determined to have the condition at birth, the chances of success are great. Older children can achieve success in eliminating hip dysplasia but the process is more extensive and it takes longer for the immobilization of the hip.
Children with hip dysplasia that is not quickly or easily reduced have an increased risk of developing hip arthritis at an early age in life. It is entirely possible that, once this happens, a hip osteotomy (cutting and realigning the bones) or a total hip replacement might become necessary.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here