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Hip dysplasia: the dangers of incorrect diagnosis

Posted: 05/01/2024

What is hip dysplasia?

Hip dysplasia (or developmental dysplasia of the hip, DDH) is a congenital condition which prevents the ball and socket joint of the hip from developing properly. It is most common in first-born girls, and without proper diagnosis or treatment in early life, it can cause worsening pain, limping, and struggling with physical activities or sport.

A recent BBC article has highlighted the severity of hip dysplasia in some babies. Athena was just two weeks old when diagnosed with the most severe form of DDH. After initially being fitted with a harness to support her hips, Athena suffered a femoral nerve palsy after ten days, where the nerve became trapped and caused loss of movement. Unfortunately, she had to undergo surgery as a result and was subsequently fitted with a spica cast for 12 weeks, immobilising the thigh, hip and pelvis.

Newborn screening

All babies’ hips are checked as part of the newborn physical screening examination within 72 hours of birth. The NHS advises that if a baby’s hips feel unstable, they should be referred for an ultrasound scan between four and six weeks old. When diagnosed at this early stage in a baby’s development, DDH can often be treated successfully, without the need for invasive surgery. Instead, a fabric splint called a Pvalik harness can be used to secure a baby’s hips in a stable position. Whilst the harness must be worn constantly for 6 to 12 weeks, it allows the baby’s hips to develop normally thereafter.

In some cases, as with Athena above, the harness will not be enough to stabilise the hips and surgery will be required. However, this is far more common where babies are diagnosed with DDH after the age of six months. The most common surgery is reduction, where the femoral head is placed back into the hip socket.

Missed opportunities for early diagnosis 

Physical examination at an early age is not 100% accurate, experts suggest, as this only detects hip instability at the time of examination, and is not able to detect problems in later life. Routine hip examinations finish after the six to eight week check and so parents and carers are best placed to identify a problem. Further, a BBC Inside Health investigation from 2019 previously highlighted that hundreds of babies were being missed by the new born physical screening programme. Research suggests that up to 15% of babies are missed in the initial screening process, equating to around 600-700 babies a year. 

Where a child has started walking prior to diagnosis, surgery is almost always required to secure the hip back into the joint. The risks also continue into later life, with increased risk of a hip re-dislocating and further surgeries. In contrast, where diagnosed early, treatment with a harness has a 95% success rate and enables the child to live normally for the remainder of their life after treatment has finished. 

In another case, one young father noticed there was something wrong when he struggled to manipulate his daughter’s legs when changing her nappy. Health visitors offered reassurance and the six-week GP check-up also missed the condition. Eventually, a physiotherapist picked up that something was wrong, but at that point they had missed the window for early treatment. The young father emphasised that ‘it should not be down to luck' whether the condition is identified and treated within the time frame to avoid surgery.

Universal DDH screening

Surgeons from Southampton Children’s Hospital have said that the rate of late diagnoses has not improved since screening started, over 30 years ago. Other countries, such as Germany and Austria, perform ultrasound scans of the hips of all newborns in order to prevent missed diagnosis by physical examination, where examining a child’s hip in the first weeks after birth can be difficult. 

However, the director of screening at Public Health England, Anne Mackie, has previously opposed the suggestion of a universal scan, stating that this can cause more harm than good. It could lead to babies being treated unnecessarily, which is particularly damaging as wearing a split in the crucial early months of life can affect the bond between mother and baby.

More information

The Global Hip Dysplasia Registry gathers information about hip dysplasia cases on an international level and compares the outcomes, with a view to addressing current gaps of knowledge and optimising patient care. More information about the condition and its research can be found on its website, here.

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