No delay in diagnosing cause of child's hip problems but Trust's handling of the complaint was inadequate

What happened

Miss A's son, P, had had treatment for septic arthritis (an infection in a joint), and had been having physiotherapy. After about three months, he was referred to a consultant orthopaedic surgeon with worsening hip pain. Several possible causes were considered but discounted and he was referred to a consultant paediatrician. Around the same time, P had an assessment of his walking. The surgeon was to arrange an MRI of his hip and spine. The paediatrician thought the pain was due to P's leg length discrepancy. The surgeon saw P again and he then had an operation to correct this.

A month after the operation, P was discharged from physiotherapy, pain free. Three months later, the surgeon and the paediatrician both reviewed him. His hip was difficult to move without pain. P was referred for further physiotherapy to strengthen his joint. Two months later, he saw the paediatrician again following concerns from the physiotherapists about his pain and lack of improvement. The paediatrician arranged for tests; however, in the meantime P was admitted to hospital with severe pain. He was diagnosed with avascular necrosis.

What we found

Avascular necrosis should have initially been considered but was not. However, in the absence of a single agreed standard of good practice, we could not say that it was a failing not to carry out an MRI at that point. (An MRI helps with diagnosis in early avascular necrosis.) There was a missed opportunity to arrange an MRI following the assessment of P's walking.

This was also a shortcoming. Due to the unusual presentation of P's avascular necrosis with pain–free periods, there were no further missed opportunities. The shortcomings did not amount to service failure.

However, we found maladministration in the way the Trust handled Miss A's complaint. The Trust admitted failings without considering whether there were failings, failed to put in place action to address the failings it had apparently found and failed to fully explain why, after all, it did not consider there were failings. The failings in complaint handling added to Miss A's distress following P's diagnosis of avascular necrosis.

Putting it right

The Trust apologised to Miss A and paid her £250. It also sent us details of the actions it was taking to make sure it met its complaint handling standards.