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What is Congenital Hip Dysplasia?

As a purely descriptive turn of phrase, congenital hip dysplasia doesn’t tell the uninitiated that much, truth be told.

Thankfully we readily inform anyone viewing this guide to this very subject matter, that congenital hip dysplasia is the clinical term used to explain a medical abnormality whereby a child’s hip joint hasn’t developed as it should.

The physical upshot being that the sufferer’s thigh bone is effectively unstable in the hip socket, something which significantly compromises the range of conventional movement which is otherwise expected of this limb. Basically, the ligaments within the hip joint generally become stretched and loose (with varying degrees of severity dependent on the individual case), often resulting in cases where the ligaments are considered too loose to hold the joint securely in place.

In the worst case scenario, the thigh bone can become completely displaced from the hip socket as an affected baby develops.

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The term hip dysplasia is prefixed – in this specific instance – by the word ‘congenital’ as it signifies a condition which is present from the time of birth, essentially.

Sometimes, according to medical experts, it’s possible to recognise that an infant has congenital hip dysplasia simply by observing them and their movements; not least with appearance playing an instant – and obvious – part in arriving at this conclusion. And that’s due to one leg visibly appearing longer than the other (although this isn’t always the case, just for the record). Indeed, with some babies it’s virtually impossible to confirm whether or not they’ve got congenital hip dysplasia by sight alone, with the only way of successfully diagnosing by way of a physical examination.

What causes hip dysplasia in new-born babies?

It’s a medically known fact that loose hips around the time of birth is the underlying cause of congenital hip dysplasia in infants, which manifests in the expectant mother whose normal hormones (which are more prevalent during the pregnancy cycle) help to naturally relax ligaments so as to make the act of impending childbirth that much more easier.

As healthcare practitioners with knowledge in the field of gynaecology will tell you, the left hip tends to be more frequently involved than the right, largely due to the normal position in which an unborn baby rests whilst in its mother’s womb; and which ostensibly stretches the left hip more than the right. This accepted instability has been witnessed in as many as 15% of new-borns, while other noted contributing factors and influences include a general lack of room in the womb, girls being more susceptible on account of historically possessing increased laxity in ligaments, hereditary patterns (when one person in the family has hip dysplasia, the chance of hip dysplasia needing treatment is 5 – 10% for subsequent children) and the breech position (which also is known to stretch the hips).

How common is congenital hip dysplasia?

Well, firstly some level of hip instability commonly occurs in new-born infants, however the precise frequency of the condition (and which requires treatment) has a statistical tendency on a number of variables. These include nationality, gender, race and other factors from the outset, yet to bring some rudimentary maths into the congenital hip dysplasia equation; research suggests that some 2 – 3 children per 1,000 need treatment for the condition.

That said, alternative studies have forecast that what’s referred to as ‘mild instability’ has been clinically reported in 1 in 6 infants (the equivalent to the 15% we mentioned earlier), yet it’s worth pointing out that with regards to mild instability this has a habit of resolving itself spontaneously. Furthering the gender element though, and congenital hip dysplasia is said to be approximately 4 times more common in girls as opposed to boys.

Although health bodies concede that genetics plays a role in the presence of congenital hip dysplasia, it’s firmly believed that it’s not a direct cause of the condition. Glancing at a few of the stats available on the other hand, might lead some to re-question just how big a deal genetics is in relation to the potential prevalence of the condition. Take the following figures for example;

  • Should an existing child already have been diagnosed with congenital hip dysplasia, the risk of another child having it = 6% (or 1 in 7 likelihood)
  • Should a parent have congenital hip dysplasia, the perceived risk of their new-born being diagnosed with it = 125 (or a 1 in 8 chance)
  • Should both a parent AND an existing offspring suffer from congenital hip dysplasia, then the risk to a subsequent child = 365 (or a greatly increased 1 in 3 possibility)

 

Addressing the law of averages in this case, (collectively) these percentages reveal that broadly-speaking, some 1 out of every 10 new-born infants will be affected by a form of hip instability, providing a parent (or sibling) already has congenital hip dysplasia.

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Are there are particular signs I need to look out for if I suspect my child has congenital hip dysplasia?

Depending on the child’s age, there are different signs to remain vigilant for, yet having said that even complete hip dislocation is not necessarily painful pre-adolescence. But if we’re taking a broader view of signs to look out for then uneven creases in the bottom or extra folds of skin at the upper thigh can be one sign that there is a leg length difference which might indicate congenital hip dysplasia in an infant from the get-go.

Elsewhere a decrease in flexibility could be observed during the nappy period, and as a rule of thumb if an infant’s hips can’t be almost fully stretched out to the side, this can be (as well as being put down to tight muscles) associated with the presence of congenital hip dislocation. After the conventional walking age, a waddling (or uneven) gait can also be a sign of hip dislocation, however in the event of both hips being affected by hip dysplasia, the condition may be harder to detect.

How/when is congenital hip dysplasia first diagnosed?

For the most part every baby should be given a physical examination by a healthcare professional at birth, so as to establish whether or not they have congenital hip dysplasia. It’s imperative that this diagnosis is made as soon as is possible after the birth, as the longer the condition goes unnoticed/left untreated, the more difficult it is to correct going forward.  It’s for this reason that follow-up checks for congenital hip dysplasia are also routinely made by health visitors.

What happens if Congenital Hip Dysplasia is not diagnosed properly?

If healthcare providers fail to diagnose congenital hip dysplasia in the crucial passage of time immediately after birth, it’s more than possible that the problem could go entirely undetected until the infant reaches the age where they begin to walk; which might well be the first juncture at which the typical signs – including a limp or uneven gait – are observed.

Unfortunately by this stage the condition could have deteriorated to the point where some of the damage cannot be corrected and the only treatment options available in some cases may involve invasive surgeries.  If treatment is delayed beyond 2 years of age, hip deformity can lead to painful hips, a perceivable waddling walking style and a decrease in strength.  If untreated altogether, osteoarthritis (a painful hip disorder characterised by joint cartilage being gradually depleted and joints becoming stiff and less mobile) and other hip deformities can develop in young adulthood. The probable reality is that the child may never recover their full agility and experience pain and difficulty walking throughout their adolescence and into and throughout their adult life.

Are there any treatment/methods of coping with congenital hip dysplasia?

Yes. If and when an infant/child is diagnosed with congenital hip dysplasia they could be immediately placed in a special harness or splint, which holds the hip in the socket of the hip joint by keeping the thighs apart. An infant will wear this for around 3 months.

If treatment starts after a child suspected of having/diagnosed with congenital hip dysplasia turns one, the youngster might need traction and possible surgery, followed by 6 – 9 months wearing a special plaster cast; with the cast changed every few weeks to allow for growth. Sadly the later congenital hip dysplasia is diagnosed (and subsequent treatment started), the more difficult it is to fix.

How to make a claim for congenital hip dysplasia

Should Congenital Hip Dysplasia remain undetected until the child can walk, as we’ve already highlighted the condition may be too far advanced to think about corrective/adoptive measures due to the potential extent of the irreversible damage which might have taken place.

If it’s proven that a diagnosis of congenital hip dysplasia has been medically missed/overlooked by those healthcare professionals responsible – leaving the sufferer wide open to a later susceptibility to the development of osteoarthritis amongst other associated conditions – then it may be worthwhile considering a medical malpractice claim.

Therefore if you believe that the diagnosis of a child’s congenital hip dysplasia was delayed due to the negligence of medical staff, you may be able to make a claim for damages. Suffice to say any financial compensation ultimately awarded a claimant if successful in their pursuit, would ideally help to cover the cost of any care a child needs in the future. It may even be possible to settle the claim on the basis that a child can make a second claim in the future if osteoarthritis does develop in later life.

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