Delayed diagnosis of developmental dislocation of the hip: the Western Australian experience.
BACKGROUND
A delay in the diagnosis of developmental dislocation of the hip has many long-term consequences. This retrospective study was undertaken in order to establish an incidence of late-presenting developmental dislocation of the hip in Western Australia, and investigate possible causes for missed diagnoses.


METHODS
Data were collected retrospectively from 1 January to 31 December 2010. Theatre records were searched for operative descriptions including the words 'arthrogram hip', 'EUA hip', 'closed reduction hip', 'open reduction hip' and 'spica'. Medical records were checked to establish the demographic details and background history of cases identified. Delayed diagnosis of developmental dysplasia of the hip (DDH) was defined as a dislocated hip requiring operative reduction, diagnosed at age greater than 3 months.


RESULTS
Seventeen children with 21 dislocated hips were identified. Age at diagnosis ranged from 6 months to 5 years. Girls accounted for 88.2% (15/17) and the left hip was involved two-thirds of the time (14/21). Bilateral dislocations were found in four children.


CONCLUSIONS
This study has identified an incidence of late-presenting developmental hip dislocation of approximately three times the previously established rate. Possible reasons for this are explored. Additional retrospective audit is now underway, and changes are already in place to ensure that infants with DDH born in Western Australia are identified and treated as early as possible.
Department of Paediatric Orthopaedic Surgery, Princess Margaret Hospital, Perth, Western Australia, Australia.
Ryan
R
Lisle
Michelle
M
Boekelaar
Katherine
K
Stannage
Colin
C
Whitewood
D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006618:Hip Dislocation, Congenital / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008485:Medical Audit; D012189:Retrospective Studies; D014904:Western Australia / Q000453:epidemiology