The subject of delayed diagnosis of Hip Dysplasia is an emotive one. Make no mistake, there are quite number of very angry people out there who are living with long term pain and disability or early hip replacements as a result of their missed diagnosis. It can also be difficult as health professionals to hear when we aren't getting something quite right, and it can be easy to feel defensive when somebody points this out. But getting defensive can prevent us from changing or improving practice for patients where it is needed and can ultimately mean we get stuck in a rutt, continuing to make the same mistakes as before. It is said that "Insanity is doing the same thing over and over again and expecting different results."
So, I've done some brainstorming of what I think are the reasons behind this issue. These thoughts are taken from mine and others' experiences, snippets from the (sparse) literature and insights from the frustrations and reasoning that have been batted back and forth between academics, clinicians and other patients involved in the Hip Pain Cardiff research group. I've also included some ideas of things we can do in practice to tackle this - or some things which are already taking place. I'm hoping future research publications should highlight these issues and solutions further.
Click on the images to zoom in. Link to PDF is here.
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| Mindmap 1: Some Reasons |
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| Mindmap 2: Some Solutions |
I've included below explanations of some of the terms used for any of my readers who aren't familiar with them.
PAO = Peri-acetabular Osteotomy
Pelvic Osteotomy surgery designed to re-orientate the acetabulum of a dysplastic hip and delay the onset of osteo-arthritis. PAO has a steep learning curve and consequently very few surgeons across the country are experiened enough to gain good outcomes with it.
Birmingham Interlocking Pelvic Osteotomy (BIPO)
Also known as Triple Pelvic Osteotomy (TPO). And alternative to the PAO that has been developed with slightly fewer risks than the PAO and a less steep learning curve.
Young adult
In orthopaedics this usually means anyone under 50
Ortho = Orthopaedic surgeon
HCP = Health Care Professional
MSK = Musculoskeletal (an area of healthcare/physio focussing on bone & joint problems)
GTPS = Greater Trochanteric Pain Syndrome
Otherwise known as Gluteal Tendinopathy. Used to be commonly diagnosed as Bursitis
OA = Osteo-arthritis
THR = Total Hip Replacement
FAI = Femoro-acetabular Impingement
Dx = Diagnosis
Rx = Treatment
Mx = Management
