Hip Dysplasia, or Developmental dysplasia of the hip, (DDH) is a congenital (present at birth) condition of the hip joint. The hip joint is created as a ball and socket joint. In DDH, the hip socket may be shallow, letting the “ball” of the long leg bone, also known as the femoral head, slip in and out of the socket. The “ball” may move partially or completely out of the hip socket. According to the International Hip Dysplasia Unit https://hipdysplasia.org/developmental-dysplasia-of-the-hip/causes-of-ddh/, hip dysplasia is the most common abnormality among newborns, 6 in 10 cases occur in first born children, 8 in 10 cases are female, and it is 12 times more likely when there is a family history of it.
Hip dysplasia can affect one or both hips (called bilateral hip dysplasia). Early diagnoses and treatment is critical, and a standard part of evaluation of a newborn after birth and during their first year of life is the performance of hip exams. If a diagnosis is made in the first 3-6 months of birth, a newborn can be placed in a Pavlik harness (a cloth brace) which is worn for 6-8 weeks. The harness has a success rate of 90%-95% of cases diagnosed by six months of age. In the rare case that there is no stabilization with the use of a pavlik harness, a child is placed in a foam and plastic hip abduction orthosis. This stabilizes the hip successfully 87%-93% of the time. In the few remaining cases in which the hips have not responded to either the Pavlik harness or the foam abduction orthosis, a closed reduction is successful 94% of the time, and the remainder require an open reduction surgery. It is well established that the later a diagnosis is made, the more difficult treatment becomes with a higher rate of complications.
When a newborn’s hips are examined in the first 4-6 months the Barlow and/or Ortolani tests are used. They involve the abduction and flexion of the hips. The pediatrician feels for a click or a clunk – indicating an out of position hip being moved in and out of its proper position (the socket). Pediatric guidelines state that these exams should be performed on one leg at a time. After the 4-6 month time frame the newborn’s muscles tighten and, therefore, as a baby gets older pediatricians add the Galeazzi sign/test. During this exam the baby is lain on its back with its hips and knees flexed. The exam will show whether one of the newborn’s legs is longer than the other which is an indication that he or she has hip dysplasia.
Beyond these exams there are other signs that will indicate whether a newborn child has developmental hip dysplasia. These include asymmetry of the gluteal folds (the creases beneath the buttocks), an abnormal gait (limping or waddling), an exaggerated lumbar lordosis (exaggerated inward curvature of the lower back region). To confirm the diagnosis of hip dysplasia an ultrasound is performed on the newborn.
Unfortunately if there is a delayed diagnosis of hip dysplasia your child will likely have an awkward, waddling gait and other difficulties walking, numerous open reduction hip reconstructions, castings, plate and screw removals, and corrective surgeries, and the need for early hip replacement – with open reduction surgery for late diagnosis of hip dislocation achieving only a 54% of survival of the hips at 45 years.
If your child’s treating physician or other treating doctors failed to do the proper tests to check for hip dysplasia in his or her first year of life, or missed what should have been an obvious case of hip dysplasia for other reasons, you and your child could have a medical malpractice claim. The attorneys at the Thistle Firm are experienced at handling these claims. If you believe your child’s hip dysplasia was missed or improperly treated the attorneys at the Thistle Firm are here to answer your questions at 215-525-6824.