All new born babies in the UK have their hips examined. Checking for issues with babies’ hips started in 1986 and doctors are looking for developmental dysplasia of the hip (DDH).
Developmental dysplasia of the hip is a condition where the "ball and socket" joint of the hip does not form properly. This socket of the hip is too shallow and so the head of the thigh bone is not held in place, making the hip joint loose. If the hip joint is loose then the hip can come out of the socket or dislocate. DDH is more common in girls than boys, and more common in the left hip.
Babies' hips are checked as part of a physical examination within 72 hours of being born (usually before they are discharged from hospital), and again between 6 and 8 weeks old.
An examination involves gentle manipulation of a baby's hip joints to check if there are any problems. If a baby is thought to be at risk, or a problem is suspected then a scan will be performed, which will either rule out or confirm a diagnosis of DDH.
Without early treatment of DDH this may lead to the child having problems later in their lifetime including a shortened leg, limping, hip pain, and painful and stiff joints (osteoarthritis).
In contrast, if hip dysplasia is picked up early, this can be treated with a removable splint which is worn for 2 – 3 months, whilst the bones and ligaments develop. With early diagnosis and treatment, most children develop normally and have a full range of movement in their hips.
Surgeons from Southampton Children's Hospital have researched the rate of late diagnoses of hip dysplasia. The research, by orthopaedic surgeons in The Bone and Joint Journal looked at 754 cases of children diagnosed late with the hip problem (after the age of one) between 1990 and 2016. They found that there was a delay in diagnosis at a rate of 1.28 cases per 1,000 births.
The current routine hip check at birth does not involve any scans, and just a clinical examination by a doctor or midwife. However it has been recognised by Alexander Aarold, consultant orthopaedic surgeon at Southampton, that "The signs are easily missed. They can be subtle.” He added "Doctors, midwives and nurses may be doing the checks and if they are not used to seeing hip dysplasia, it is hard to pick up."
Unfortunately the study has found that despite screening taking place for over 30 years, the current examination approach in the NHS has failed to reduce the number of children receiving late diagnoses. Mr Alexander Aarold has commented that that delay in diagnosis of hip dysplasia is a significant public health issue.
Professor Anne Mackie, director of screening at Public Health England has suggested that scanning all newborns could cause more issues, “Offering a universal scan can cause more harm and evidence shows that it can lead to 20 times more babies being unnecessarily treated compared to the UK programme.”
However, in other countries including Austria and Germany, ultrasound scans of the hips are routinely performed on all new born babies and late diagnosis of hip dysplasia is very low as a result.
Tim Theologis, president of the British Society for Children's Orthopaedic Surgery commented: "This study has provided evidence that the current selective screening for neonatal hip dysplasia is ineffective and the percentage of infants diagnosed late is unacceptably high."
Public Health England has now indicated they are planning to introduce some changes to the screening process and are investigating providing more training for clinicians carrying out the examinations.
Freeths solicitors have experience of medical negligence claims following delays in diagnosis or delays in receiving treatment. Such delays in receiving effective treatment have the potential to lead to significant life changing damage.
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For more information about this news story please see the following BBC News article: https://www.bbc.co.uk/news/health-47735103
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