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Your guide to dysplasia of the hip (DDH)

Baby's legs - dysplasiia of the hip DDH

The physical examination carried out on new born babies just after birth should enable the medical practitioner to identify babies who have congenital hip dislocation or developmental dysplasia of the hip so that they can be treated.  However, sometimes the condition is not picked up and this delayed diagnosis may mean more extensive treatment and surgery and disability stretching into adulthood.

DDH could go undetected until your child starts to walk

If your baby was not given the required physical examination just after birth to check for developmental dysplasia of the hip (DDH), the condition could go undetected until your child starts to walk - but with a noticeable limp.

When a health visitor, medical practitioner or a doctor makes the vital checks on a newly born child and a displaced hip joint is diagnosed, treatment can be easily and safely administered.

But if this condition is not detected until the child starts to walk, it may already be too late.  The condition is likely to be causing pain and there is a permanent difficulty in walking, impaired agility and the risk of developing early arthritis (loss of joint cartilage in the hip joint).

If your child suffers with DDH, which was only diagnosed much later

Late stage diagnoses of DDH will require an operation which can be complicated.

You may feel that you have grounds for a medical negligence claim

As experienced medical negligence specialists, we know that investigating a medical negligence claim may feel like a very big step to take, but we will provide caring support throughout the claims process. Our dedicated team of specialist solicitors has many years of experience in successfully resolving medical negligence claims. We can help you find out why the system failed to provide the appropriate care at the right time and, crucially, obtain answers and compensation to ensure that your child’s future financial needs arising because of the negligence are met.  These may include treatment, equipment, support and accommodation.

Risk factor numbers

  • 1 in 1,000 babies are born with a dislocated hip
  • Around 2 in 10 cases of DDH affect both hips
  • Around 6 in 10 cases of DDH occur in first-born children
  • 1 in 3 newborns have some degree of instability of the hip.
  • Around 8 in 10 cases of DDH are female.                                                   ( Patient.co.uk)

What is developmental dysplasia of the hip (DDH)?

Developmental dysplasia of the hip (DDH) - previously known as congenital dislocation of the hip (CDH) -  is one of several types of abnormality.  It is specifically related to the way that the hip joint develops and is present at birth. 

The abnormality is found in the ‘ball and socket’ joint of the hip, either in the:

  • Shape of the head of the ‘ball’ (the round top of the thigh bone) or
  • Shape of the ‘socket’ (round, cup-like structure within the pelvis) in which the head of the ‘ball’ sits or
  • Supporting structures

When a ball and socket are not in close contact there are two levels of abnormality:

  • Subluxation - a mild abnormality where there is some contact between ball and socket
  • Dislocation - a severe abnormality where there is no contact betweenball and socket.

Causes of developmental dysplasia of the hip (DDH)

The causes of DDH can be unclear and are not entirely understood.  However, there are several risk factors known to doctors, clinicians and health visitors, which contribute to the likelihood of a baby being born with DDH.  These are:

Family history - a baby is five times more likely to have DDH if a parent, brother or sister was born with the same condition.

Gender - the female hormone, oestrogen, made by the unborn female baby, causes the ligaments to relax and be more pliable during labour and could make the bones more likely to move out of position.

Womb conditions – the risk of developing DDH is increased if the baby is not able to move about as much

- in more than half of first pregnancies when the womb is tight

- if there is only a small amount of fluid in the womb.

Abnormal positioning – an unborn baby has a risk of DDH seven times higher if it is in the breech position (feet down in the womb) or if the knees extend out with the feet near the head.

DDH in the left hip - the most common type of DDH affecting the left hip is thought to be caused by the majority of unborn babies who lie against the mother's spine on their left side. The position may put more pressure on the left hip, increasing the risk of abnormal development.

Other risk factors - include cerebral palsy, spinal cord problems or other nerve and muscle disorders, such as an inward curving of the foot. DDH is also more common in premature babies or babies born weighing more than 5 kg.

Swaddling  -  following birth, a newborn can be too tightly swaddled around the hips. A baby should have sufficient room for movement with hips and knees bent slightly and turned out.

Examining for DDH

A baby should be examined for DDH:

  • Within 24 hours of birth
  • At a 6-week check
  • Between 6-9 months
  • At walking age

A newly born baby with DDH will not show signs of distress or appear to be in pain.

Soon after birth, most babies should be examined by a hospital doctor to detect for signs of DDH.  When DDH is suspected the hospital may advise you to return for a further examination.

Often, newborn babies have an unstable hip at birth caused by soft and lax tissues, which becomes stable by itself as the soft tissues tighten over a period of between 6-8 weeks.

Sometimes, just by examining a newborn baby's hips, a slightly dislocated hip can be relocated into the correct position and made stable.

Detecting symptoms of DDH

The doctor will bend the baby's knees and turn the thighs outwards to feel for a ‘clunk’, which may indicate that there is a problem with the hip.

Two other signs of a hip problem are:

  • Unequal skin folds between the legs – which also occur in around 1 in 4 of normal babies
  • Body may not be equal on both sides
  • Thigh bone may look shorter on one side.

Older children: Children with DDH who have started walking may have a noticeable limp and also walk on their toes.

Testing for DDH

If instability persists, then further tests should be carried out:

At 4-6 months – ultrasound scan, which uses sound waves to construct a picture of structures in the body, routinely carried out on women early in their pregnancy.

Over 4-6 months - an X-ray picture of the pelvis and thigh bone.

Treating DDH

The earlier treatment is started after birth, the greater the chances of success and a reduction in the possibility of long-term complications. If the head of the thigh bone is not relocated then the hip joint will continue to develop abnormally.

The aim of treatment is to relocate the head of the ‘ball’ of the thigh bone into the ‘socket’ of the pelvis and enable the structures of the hip joint to become established normally.

The success rate of simple, non-surgical treatments reduces significantly after 7 weeks of age. Depending on the age of the child there are a number of commonly used treatments:

Pavlik harness (for children under 6 months old) - a device used to hold the hips in the correct position by keeping the legs bent and turned outwards. The harness is worn continuously for at least six weeks and adjusted as the child grows and as the hip stabilises. X-ray pictures will need to be taken throughout childhood until the bones have fully developed.

Closed reduction and hip spica (forchildren over 6 months of age) under local anaesthetic, the hip is correctly repositioned, which is checked by an MRI or CT scan after the procedure. A special cast is applied to keep the hip in the right position and is worn for at least 12 weeks.

Open reduction (for an older child) - an operation to loosen the tendons around the hip and remove any obstacle preventing the hip from moving freely. Once the bones are in a good position, the joint is strengthened.

Other types of surgery

If DDH has not been resolved by 18 months, more complicated surgery is required. This involves removing some parts of the bone and joint so that the hip can be kept in the right position.

What if DDH is not treated?

If your child's DDH is not diagnosed and treated early, then early arthritis may develop in the hip joint, which causes pain and reduced movement. The treatment of DDH is more complicated and has a lower chance of success once a child's bones have fully developed.

The longer-term prospects worsen if diagnosis or treatment is delayed until the child has begun to walk.

Around a third of hip replacement operations carried out on those under the age of 60 years are the result of DDH which was untreated, unsuccessfully treated, or delayed in treatment.

How Your Legal Friend can help you..

As experienced medical negligence specialists, we know that, if your child has been affected by an undiagnosed or delayed diagnosis of DDH, you will want to seek an explanation for why you were badly let down.

Our dedicated team of specialist solicitors has many years of experience in successfully resolving medical negligence claims. We can help you find out why the system failed to provide the appropriate care at the right time and, crucially, obtain compensation to ensure that your child’s future needs for care, treatment and support are met.