AMount Gambier mother is advocating for infant ultrasounds to be enforced at hospitals for the early detection of Developmental Hip Dysplasia.
Liza Kirby’s daughter, Chloe Kirby, did not receive the ultrasound at birth and showed no symptoms of hip dysplasia until she was around two-years-old.
“We were concerned about her falling over when she was walking and her hips clicking a bit or something that just did not seem quite right,” Ms Kirby said.
Ms Kirby took Chloe to paediatric physiotherapist Dr Sue Charlton, who was concerned about her symptoms.
“She had an ultrasound when she was about two-years-old, and it must have been very obvious because before I even got home from town, I had a phone call from the department, and they had organised an appointment with the orthopaedic surgeon the next day,” she said.
Chloe underwent surgery on both hips simultaneously and was in a plaster from under her arms to her ankles for six weeks.
“It was very major surgery, she had an anaesthetic, she had blood transfusions, I think it was about a four-hour surgery and then she was in the Women’s and Children’s hospital for a while,” Ms Kirby said.
Chloe’s hip was bone grafted on the hip socket to bring it down to close over her femur, which was cut and rotated to fit in the hip socket properly and 12 months later the plates and screws were removed.
“She had to go and see the surgeon and have x-rays every 12 months to see how it was going up until she was about 18-years-old,” Ms Kirby said.
“She has ongoing issues with her hips.
“She still, to this day, gets quite a lot of pain in her hips walking long distances.
“She walks differently, and she cannot walk for as long and things like that, it definitely still affects her.”
Chloe is now 22-years-old and is a target for a hip replacement much earlier than the usual age for a hip replacement.
“You can only have two hip replacements they say in your life, so you do not want to have a hip replacement too early because that one will wear out and then she has to have another one too early, so it affects her for the whole of her life,” Ms Kirby said.
Ms Kirby compared Chloe’s case to her friend’s daughter, who had a brace for hip dysplasia when born.
“It is much better for a parent to manage it from that point than to do it in our situation much later,” she said.
“After seeing somebody with it picked up early compared to having it not picked up for two years and seeing what we had to go through, a couple of surgeries for a two- and three-year-old, any parent will know what it’s like putting their child under a general anaesthetic, it is not a lot of fun.”
Dr Charlton said if symptoms were not identified until eight or 12-months-old, children would have ongoing problems throughout their entire life.
“Over the years treating children as a paediatric physiotherapist, I have had the unhappy experience of seeing older children with dislocated hips, they have not been diagnosed and perhaps they are not walking properly, maybe they have not even begun to walk,” she said.
“If you find the problem before the child is 12-weeks-old, you can get a 100% recovery because the hip is immature enough in its development to develop alright when it is placed in the right place.
“After that, you have a much lesser chance of making a good recovery.
“It usually requires traction to get the hip into the right spot or a general anaesthetic and cutting of muscles and all sorts of things, but it never ends up with a proper socket, so most of those children require a total hip replacement before they are 30.
“Their treatment will also take them off their feet for some time and then they will not be able to walk as well as a normal child can, they will not be able to take part in sporting activities, they get pain, the leg is often a bit shorter.”
Dr Charlton said children born in regional South Australia have been reported to be at an increased risk of late diagnosis of hip dysplasia.
Ms Kirby encouraged the ultrasound to be done at birth so issues could be identified, and treatment could begin from infancy, preventing surgery and a longer path of complications.
“There is a much less invasive way to have it corrected if it is identified early,” she said.
“I am sure Chloe would have been checked in the hospital, I cannot remember, but I’m sure she would have been, it obviously was not identified, whereas if she had been ultrasounded maybe it would have been.
“Sometimes it is probably easy to miss but sometimes it is more obvious, and what the ultrasound is going to do is pick up the less obvious ones like Chloe that get missed.”
The Limestone Coast Local Heath network (LCLHN) has responded to an enquiry about checks for the early detection of Developmental Hip Dysplasia.
The LCLHN spokesperson said physical examinations for infant hip dysplasia checks were routinely made as part of health and development assessments in South Australia, conducted by a paediatrician or General Practitioner.
“If any concerns are identified, standard practice is to follow this with an ultrasound screening,” the spokesperson said.
“Concerns may include babies born breech or those with known family history of hip dysplasia.”
“All newborns have their hips checked prior to discharge and signed off in Blue Books, which record children’s growth and development, vaccinations and immunisations, and developmental milestones,” the spokesperson said.
“The Limestone Coast Local Health Network also have a joint Clinical Practice Guideline, authored by a physiotherapist, paediatrician and women’s health orthopaedic team, to ensure that all newborns with an abnormal hip exam at their 24-hour check are monitored as per this protocol.
“Hip dysplasia checks are also regularly performed between birth and 5 years through Child and Family Health Services standard health and development checks and paediatrician appointments.”
The LCLHN spokesperson said children in South Australia should have standard health and development checks between birth and five years at the ages of 1 to 4 weeks, 8 weeks, 6 to 9 months, 18 to 24 months, 3 years, and 4 to 5 years.
