After a baby is born, lots of checks are carried out on the baby by the doctors and midwives to ensure that they have developed as expected. This includes physical checks at 72 hours of age and again at being 6 and 8 weeks of age, known as the Newborn and Infant Physical Examination (NIPE) screening programme, which involves a hip manipulation check. These checks involve manoeuvres called the Barlow test, which checks for dislocatable hip, and the Ortolani test, which checks for a dislocated hip.

The hip check is specifically looking for evidence of hip instability, such as if:

• If one leg cannot be abducted (moved) as far as the other;
• If one leg seems to be longer than the other
• Restriction of the level of the knees when hips and knees are flexed

For most babies, the results are normal but for 1 in 100 children, a hip abnormality known as hip dysplasia is identified which will need treatment. Hip Dysplasia is a developmental condition that causes one or both of the hip joints to form incorrectly, meaning that the ball and socket of the hip does not fit together as it should. This can result in instability, dislocation and shallowness of the hip socket and it can range in severity from mild looseness to complete hip dislocation. It is more common in the left hip as well as being found more frequently in:

• Girls
• Firstborn children
• Families with a history of hip issues
• Babies born in the breech position.

The earlier hip dysplasia is identified, the better; if there is a delay with it being diagnosed, this can have significant and potentially lifelong consequences for the child. If abnormality is noted, your child will be referred for an ultrasound scan, from which it will be confirmed if there is hip dysplasia.

Making this vital assessment of whether there is hip abnormality is very much dependent upon the skill and expertise of the person carrying out the examination and this means that there is scope for human error, namely missing a hip abnormality. It can sometimes be challenging to identify hip dysplasia using the manual assessment, particularly if it affects both hips as there will not be an obvious asymmetry.

Even the UK national screening committee accept that the NIPE screening programme is not as effective as would be hoped; the statistics speak for themselves whereby the number of children in the UK presenting late with hip dysplasia is higher than in other countries such as Germany, Austria and Poland who have a screening programme that involves ultrasound scanning.

If it is diagnosed quickly, treatment is often less invasive, namely using a Pavlik Harness. This is a fabric harness that holds the child’s legs in a ‘frog-like’ position for around 6-12 weeks, to enable the hip joint to develop correctly. 3 to 5 out of every 1,000 births may require a Pavlik Harness.

It is imperative to detect hip dysplasia as soon as possible, as undetected unstable hip(s) with delayed treatment can require complex surgery which may otherwise not have been needed and may result in long term complications.

The most common surgeries are hip reductions (fitting the femoral head back into the socket), osteotomy (cutting and realigning the bone) or in the most serious cases, a hip replacement.

A 2024 study by the University of Liverpool identified that around 500 children a year undergo hip surgery due to missed and delayed diagnoses of hip abnormalities, and that half of these were missed during testing as infants.

Parental concerns should be listened to by medical professionals and if you have any concerns about your child’s hips, whether as a newborn or when the child is older, you should contact your doctor to discuss. The most common signs of hip dysplasia in older children is:

• Being unable to, or struggling to move the leg out sideways
• One leg is longer than the other
• One leg drags when walking
• Walking with a limp.

With early diagnosis and treatment, a child is more likely to develop normally but with a delay in diagnosis, it can cause permanent pain and stiffness in the hip joint, a difference in leg length, hip instability, and a serious impact on a person’s walking (such as a limp), sitting and ability to partake in activities. It can also increase the risk of early development of osteoarthritis in the hip and back.

If your child has suffered a delay in diagnosis and treatment of hip dysplasia, please call our offices on 01482 323 697 to discuss how we can help.