Hip Dysplasia Claims

Hip dysplasia claims are among the most complex areas of paediatric medical negligence. They require careful analysis of clinical records, expert orthopaedic opinion and a detailed understanding of how failures in diagnosis and treatment affect a child’s development over their lifetime. At Crimmins Howard, we bring that level of focus to every case.

If you believe your child’s hip dysplasia was missed, misdiagnosed or treated with unnecessary surgery, contact Crimmins Howard today to discuss your case in confidence.

What Is Hip Dysplasia?

Hip dysplasia, also known as Developmental Dysplasia of the Hip (DDH), is a condition in which the hip joint does not develop properly. In a healthy hip, the ball at the top of the thigh bone (the femoral head) fits securely into the cup-shaped socket of the pelvis (the acetabulum). In children with DDH, the socket may be too shallow, causing the joint to be loose, unstable or, in more serious cases, partially or fully dislocated.

DDH is a congenital condition, meaning it is present at or around the time of birth. It can affect one or both hips but is more common on the left side. The condition ranges in severity from mild instability to complete dislocation, and the long-term impact depends heavily on how early it is detected and treated.

If diagnosed early, DDH can usually be managed with simple, non-invasive treatments such as a Pavlik harness. If it is missed or treated too late, the consequences can be significant, including the need for invasive surgery, chronic pain, premature arthritis and eventual hip replacement.

Risk Factors for Hip Dysplasia

While the exact cause of DDH is not fully understood, several factors are known to increase a child’s likelihood of being born with the condition.

Family history is one of the strongest indicators. A child with a parent or sibling who had DDH is roughly five times more likely to develop the condition. Gender also plays a role; approximately 8 in 10 cases occur in girls, likely due to the effects of oestrogen on ligament flexibility during development.

Breech positioning (where the baby’s feet or bottom are facing downwards after 28 weeks of pregnancy) significantly increases risk. Breech babies delivered by caesarean section have a risk roughly seven times higher than average, while those delivered vaginally have a risk approximately 17 times higher. First-born children account for around 6 in 10 DDH cases, possibly because the uterus is tighter and allows less movement during a first pregnancy.

Other contributing factors include low amniotic fluid levels (oligohydramnios), premature birth, high birth weight (over 5kg), and the presence of other neuromuscular conditions such as cerebral palsy or spinal cord problems.

Understanding these risk factors matters in a legal context because healthcare professionals are expected to flag high-risk babies for closer monitoring and follow-up screening.

How Is Hip Dysplasia Diagnosed?

In Ireland, all newborn babies undergo screening for DDH within the first 72 hours of life. This involves a physical examination in which the baby is laid flat and the hips are gently moved through a range of positions. A distinctive “clunk” sound during this examination may indicate that the hip joint is unstable or out of place, and should prompt an urgent referral for an ultrasound scan to confirm the diagnosis.

Follow-up checks are also carried out by GPs at around 6 to 8 weeks, and by public health nurses at developmental checks between 8 and 9 months and again at 2 years.

Ultrasound is the primary diagnostic imaging tool for infants under 6 months, as their bones have not yet fully hardened. For older children, pelvic X-rays are used to monitor hip development over time.

Early detection is critical. When DDH is identified in the first few weeks of life, the success rate of conservative treatment is very high. When diagnosis is delayed beyond the first few months, treatment becomes more complex, more invasive and less likely to achieve a fully normal hip.

How Is Hip Dysplasia Treated?

The approach to treating DDH depends on the child’s age at diagnosis and the severity of the condition.

Pavlik Harness (Under 6 Months)

For babies diagnosed early, a Pavlik harness is typically the first line of treatment. This soft device holds the hips in a flexed and outward-turned position to encourage proper development of the joint. It is usually worn full-time for at least 6 weeks, then part-time for a further 6 weeks. For mild cases (subluxation), the harness is effective in more than 9 out of 10 children. Even in more severe cases involving dislocation, it succeeds in approximately 8 out of 10 infants.

Closed Reduction and Hip Spica (Over 6 Months)

If the harness is unsuccessful or the child is older at the time of diagnosis, a procedure known as closed reduction may be carried out under general anaesthetic. The surgeon manually repositions the hip, and a plaster cast (hip spica) is applied to hold the joint in the correct position for at least 12 weeks.

Open Reduction

When closed methods fail or diagnosis is significantly delayed, open surgical reduction may be required. This involves an operation to remove any tissue obstructing the joint, reposition the bones and strengthen the joint. Recovery is longer, and the risk of complications is higher.

Osteotomy and Further Surgery

If DDH remains unresolved beyond 18 months, more complex surgical procedures such as pelvic or femoral osteotomy may be necessary. These involve cutting and reshaping bone to create a more stable joint. Plates and screws are often used, requiring a second surgery for removal. The success rate of surgery decreases with age, and the long-term outlook is generally less favourable when treatment begins after the child has started walking.

What Happens If Hip Dysplasia Is Not Treated?

The long-term consequences of untreated or poorly treated DDH can be severe and life-altering.

Children whose hip dysplasia is missed in infancy often develop an abnormal gait, including limping or waddling. They may experience chronic hip pain from a young age, along with restricted movement and leg length differences. Many will develop early-onset osteoarthritis, sometimes requiring hip replacement surgery as early as their 40s.

Approximately 3 in 10 hip replacement operations performed on people under the age of 60 are linked to DDH that was either untreated, unsuccessfully treated or diagnosed too late. The impact extends beyond physical health; children who undergo multiple surgeries face extended hospital stays, disrupted schooling, emotional distress and reduced participation in sport and social activities.

For families, the financial burden can also be significant, with costs for ongoing medical care, physiotherapy, mobility aids and home modifications accumulating over many years.

How Does Medical Negligence Arise in Hip Dysplasia Cases?

Medical negligence in the context of DDH can occur at several stages of a child’s care.

Failure to Diagnose in Newborns

All newborn babies in Ireland should be screened for DDH within 72 hours of birth. If a healthcare professional fails to carry out this screening properly, or misses signs of instability during the examination, the opportunity for early conservative treatment can be lost entirely.

Misdiagnosis or Delayed Diagnosis

Some children present with clear symptoms of hip dysplasia at routine developmental checks, such as unequal skin folds on the thighs, limited hip movement or leg length discrepancy. If these signs are noted but not acted upon, or are incorrectly attributed to another cause, the resulting delay can lead to more invasive treatment and a worse long-term outcome.

Inadequate Treatment or Follow-Up

In some cases, children receive treatment that is not appropriate for their condition, or are not monitored closely enough during and after treatment. This can include incorrect use of harnesses, premature cessation of treatment, or failure to order follow-up imaging.

Unnecessary Surgery

Recent investigations into hip dysplasia surgeries carried out at Children’s Health Ireland (CHI) Temple Street and the National Orthopaedic Hospital Cappagh (NOHC) between 2021 and 2023 revealed that many procedures may not have met the accepted threshold for surgical intervention. Audit findings indicated that a significant proportion of surgeries at both hospitals did not satisfy the internationally recognised criteria for operating.

More than 2,200 letters have been sent to families whose children underwent hip surgery over a period stretching back more than a decade. Some of those children are now adults. If your child had a pelvic osteotomy or other hip surgery and you have concerns about whether it was necessary, you may have grounds for a claim.

Failure to Obtain Informed Consent

Parents have a right to be fully informed about the risks, benefits and alternatives before any surgical procedure is carried out on their child. If surgery was performed without adequate explanation or consent, this too may constitute a basis for legal action.

The Irish Hip Surgery Scandal: What Families Need to Know

In 2023, a clinical audit was launched into hip dysplasia surgeries performed on children at two Dublin hospitals: Temple Street (CHI) and Cappagh (NOHC). Concerns had been raised by whistleblowers about whether hundreds of children had been subjected to invasive and unnecessary surgical procedures.

A draft report from the audit indicated that the surgical threshold applied at these hospitals was significantly lower than international standards. The investigation has since been extended to cover a period stretching back approximately 15 years, with families now receiving letters about operations carried out on children who are, in some cases, now adults.

The scope of the review has expanded, and an external expert panel involving specialists from multiple countries has been appointed to examine the cases. The full report has not yet been published, and many families are still waiting for clarity about whether their child’s surgery was among those flagged.

If you have received a letter from CHI, or if you have concerns about hip surgery your child underwent at Temple Street or Cappagh, it is important to seek independent legal advice as soon as possible. Crimmins Howard can help you understand your options and take the appropriate steps to protect your child’s rights.

The Claims Process: Step by Step

1. Speak to Our Medical Negligence Solicitor

The first step is a confidential consultation where we listen to your experience in full. We will ask about the timeline of your child’s care, including when symptoms first appeared, what treatment was provided and how your child has been affected. This conversation helps us assess whether there may be grounds for a claim.

2. Obtaining Medical Records

With your authorisation, we request copies of your child’s full medical records from every relevant hospital, clinic and GP. These records form the foundation of the case and allow us to reconstruct the decisions that were made at each stage of care.

3. Independent Medical Expert Review

We commission an independent paediatric orthopaedic specialist (and, where necessary, a radiologist or other expert) to review the records. Their role is to determine whether the care your child received fell below the standard expected, and whether that failure caused or contributed to the harm suffered. If the expert supports the claim, this opinion becomes central to the legal case.

4. Assessing the Full Impact

We work with you to understand the full scope of the damage, including physical pain, emotional distress, medical costs already incurred, lost parental income due to caregiving, future treatment needs, and any long-term effects on your child’s mobility, education and quality of life. We may engage additional specialists such as occupational therapists or care planners to calculate future needs.

5. Issuing Legal Proceedings

If the evidence supports your claim, we prepare and issue proceedings in the High Court. A formal Letter of Claim is sent to the defendant hospital, clinic or practitioner, setting out the basis of the case and the relief sought.

6. Settlement or Trial

Many medical negligence claims are resolved through negotiation or mediation once the strength of the evidence becomes clear. We always seek a fair settlement that reflects the true impact of the negligence. However, if the other side refuses to accept responsibility or disputes the level of compensation, we are fully prepared to bring the case to trial. You will be supported and informed at every stage.

What Compensation Can Cover

Compensation in a hip dysplasia claim is assessed under two main categories.

General damages cover the pain, suffering and loss of quality of life experienced by the child. This includes the impact of surgery, recovery periods, restriction of activities, emotional distress and the long-term prognosis for their hip health.

Special damages cover the financial losses and expenses arising from the negligence, broken down into past and future costs. These may include:

• Medical and surgical expenses (past and future)
• Physiotherapy and rehabilitation costs
• Parental loss of earnings due to caregiving responsibilities
• Nursing or home care
• Cost of mobility aids or equipment
• Home and transport adaptations
• Future loss of earning capacity for the child

Compensation is assessed with reference to the Personal Injuries Guidelines, and the amount awarded will reflect the specific circumstances and severity of each case.

Time Limits for Hip Dysplasia Claims

Under the Statute of Limitations, the standard time limit for medical negligence claims in Ireland is two years from the date of knowledge. This is the point at which you became aware, or ought reasonably to have become aware, that the injury may have resulted from substandard medical care.

For children, the limitation period does not begin until the child’s 18th birthday. This means a claim can be brought at any time up to their 20th birthday. However, a parent or legal guardian can (and should) act on the child’s behalf well before that date. Early action ensures that medical records are preserved, evidence is fresh and the strongest possible case can be built.

These time limits are strictly enforced. If you have any doubt about whether you are still within time, contact us as soon as possible for clarification.

Why Choose Crimmins Howard?

We investigate what the system will not explain

When a child undergoes unnecessary surgery or suffers because of a missed diagnosis, families rarely receive a full explanation. We trace the entire sequence of care, identify where decisions went wrong and build a clear, evidence-based account of what happened.

We work with leading independent medical experts

Every claim we pursue is underpinned by expert opinion from consultants with direct experience in paediatric orthopaedics and hip dysplasia. Their assessments are unbiased, thorough and aligned with current Irish and international clinical standards.

We capture the full impact on your child and family

A hip dysplasia claim is not just about the physical injury. It is about the impact on your child’s development, your family’s finances, the emotional toll of repeated hospital visits and the long-term adjustments that may be needed. We ensure every aspect is properly documented and reflected in the claim.

We respect your pace, your privacy and your voice

You will never be rushed through this process. Every case begins with listening, and you will be kept informed and involved at every stage. We handle these cases with the sensitivity they deserve while pursuing them with the determination they require.

Over 30 years of trusted legal service

Based in Shannon, Co. Clare, Crimmins Howard has built its reputation on delivering consistent, high-quality results for clients across the west of Ireland and nationwide. We combine local accessibility with the expertise and resources to handle complex, high-value medical negligence claims.