DDH UK, a charity supporting families of those affected, estimate that 1 in 6 newborns will have an element of hip instability, with 2-3 in every 1,000 babies requiring treatment. Complications may arise when the condition goes undiagnosed until the child is older, at which point more intrusive treatment will be required together with the potential for long term health implications. If this delay in diagnosis and treatment is due to negligence, it may be possible to recover compensation for losses which have been suffered and cover the cost of treatment which might be required in the future.
What is DDH?
DDH, also known as hip dislocation or hip dysplasia, is where the "ball and socket" joint of the hip has not formed properly. This results in the hip joint being loose or, in severe cases, dislocated. First born children and girls are more likely to suffer from this condition and, whilst it can affect both hips, it is more common in the left.
Early Detection is Key
NHS guidelines require a baby's hips are checked within 72 hours of birth, with a further examination at between 6-8 weeks. If instability in the joint is detected at either of these examinations, an ultrasound scan should be carried out.
If diagnosed early enough, generally before the baby is 6 months old, a Pavlik harness can be used to secure the baby's hips in a stable position, allowing them to develop normally. This is a fabric splint which requires to be worn for several weeks. If this treatment is unsuccessful, or if the diagnosis is made after the baby is 6 months old, surgery will likely be required. Following surgery, the baby will require a hip cast for several months.
If diagnosed early and treated successfully, the child should go on to develop a normal hip joint with no limitations. However, even with treatment, hip deformity and osteoarthritis may develop in adulthood, particularly when treatment began after the age of 2. If untreated, DDH can lead to pain and osteoarthritis by early adulthood, resulting in pain, decreased agility and difference in leg length.
How to prevent delays in diagnosis and treatment?
Charities such as STEPS and DDH UK have expressed concerns about delays in diagnosis and treatment. Since the current screening programme was put in place over 30 years ago, the rate of late diagnosis has increased. There is speculation this is due to the difficulties in detecting DDH in babies during examinations, resulting in a failure to refer the baby for a scan.
One suggestion is for the selective screening programme to be replaced by one where all babies are screened. This is the practice in Germany and Austria, where rates of late diagnosis are extremely low. However, the concern is that this may lead to unnecessary treatment, as hip issues can resolve themselves as the baby grows without any treatment.
Nevertheless, given the impact the diagnosis and treatment of DDH can have on families and difficulties it can cause, it is clear changes are required. In response to this, Public Health England has confirmed that it is looking into providing additional training to clinicians carrying out examinations.
Making a Claim
Morton Fraser are experts in medical negligence. We act for children, and their parents, in cases involving DDH. If you or your family have been affected by a late diagnosis of DDH, we would be able to advise you on your prospects of successfully making a claim against the NHS.
To be successful in making a claim, it is firstly necessary to prove that those treating you were negligent. The court applies a strict test when considering if there has been negligence which requires you to show that there has been a mistake made by a medical practitioner which no competent doctor in that field would have made. This is a difficult test to satisfy, particularly as an individual is not entitled to a gold standard of care or best practice, and a minimum acceptable standard is sufficient to avoid negligence. Only if a practitioner has failed to meet this minimum acceptable practice, will they be considered to have acted negligently. Secondly, it is necessary to prove causation. This requires you to show that the negligence directly resulted in your loss, for example, the delay in diagnosis led to more intrusive treatment and ultimately may result in long term health implications.
Making a claim is often a stressful experience which can take several years. However, many consider it is an essential step to take. Ultimately, it may result in a change in practice within the NHS resulting in improvement in patient care and potentially preventing similar errors occurring in the future. A successful claim may also result in compensation being recovered in respect of any losses suffered. This may include a sum to cover the pain and suffering experienced, past and future care costs, travel expenses, any therapies or equipment which have been required, together with the cost of future medical treatment.