"Missed" or late-diagnosed congenital dislocation of the hip. A clinical entity.

Reported series of neonatal examinations of the hip by trained orthopedic surgeons reveal cases of dislocation of the hip discovered many months after the previous normal examination. The possibility of delayed dislocation of the hip needs further study and its recognition is important for the medical and legal professions. Physicians may be blamed erroneously for failure to diagnose CDH at an early stage. In 10 documented cases, early examinations by qualified experts revealed normal hip findings, although the patients were later discovered to have CDH. In five instances, the physical examinations were done by specialists in children's orthopedics. In one case of a child being examined for knock-knee, X-rays accidently included the hips and showed CDH. Thus, clinical signs are not infallible and an occasional case will be missed on examination even in children older than one year. Congenital dysplasia of the hip is a dynamic process and parents should be warned of the possibility of delayed dislocation. Repeated examinations of the hips are recommended.