Professor Nicholas Clarke’s research is helping families across the world affected by instability in their babies’ hip joints that, if left untreated, can limit their baby’s movement and later ability to walk, whilst bringing a much greater risk of the need for total hip replacement in early adulthood.
He is addressing significant differences in how such babies are treated across healthcare, in an epidemic of hip dysplasia that he and his colleagues are seeing in their clinics across the world. His work has already helped change clinical practice, midwifery advice and the design of swaddles, baby carriers and car seats worldwide.
Loosened joints, long-term problems
High levels of the hormone relaxin leading up to birth, used by the mother’s body to relax and soften her own hip joints, can lead to loosening or dislocation of her baby’s hip joints. Especially common where there has been family history of hip dysplasia, this is one of the commonest congenital disorders, with one in 20 babies screened at Southampton showing some form of hip instability.
Standard treatment, which involves fitting the Pavlik harness to keep the legs bent and up day and night for six weeks, is successful in 85% of babies. The remaining 15% will require surgical intervention to correct the condition or suffer permanent damage; a recent Norwegian study found that 70% of women needing early total hip replacement (at age 40 or younger) had hip dysplasia as infants.
Better care now, supporting better care in the future
With over 140 families enrolled in his weekly hip clinic, run in Southampton’s NIHR Wellcome Trust Clinical Research Facility, Professor Clarke and his team are able to give dedicated time and specialist care, whilst gaining the detailed information needed to inform development of treatment and care.
The now routine hip screening of newborns to help early identification of problems, and the use of the Pavlik harness according to a set protocol are outcomes of this research, standardising care here in Southampton and across the NHS nationally.
As well as directly improving care for parents and babies, these measures are also enabling further research to better understand the condition and identify factors that worsen the effects of dysplasia, such as tight swaddling.
A wholly avoidable epidemic
Professor Clarke has seen a surge in cases of hip dysplasia, caused by the unsafe practice of tightly wrapping babies in blankets to keep them warm and help them sleep. This approach had almost completely disappeared by the end of the 1980s following concerns about effects on infant health, but recent trends have seen it increasingly advised and adopted by mothers, with some websites selling tight ‘swaddlers’ claiming benefits in soothing colic.
“This form of swaddling used to be very common across the world but, with the help of major educational programmes it was all but eradicated and cases of hip dysplasia reduced drastically.” said Professor Clarke.
“Now, I and my colleagues across the UK and in America and Australia are witnessing its revival - while many cases of hip dysplasia are down to genetics or other conditions, swaddling is becoming an increasingly prevalent cause once again and that is extremely frustrating because it is something parents can control.”
Immediate impacts
When Professor Clarke raised the alarm about tight swaddling in 2012, drawing on work through his research clinic and the efforts of the International Hip Dysplasia Institute, the effects were immediate – influencing colleagues’ practice, the issue was highlighted by the Royal College of Midwifery and the leading manufacturer of tight ‘swaddlers’ invited him to help redevelop their products.
“My message to my clinician colleagues is that research, done in the right environment and prosecuted properly …is absolutely pivotal to clinical progress.” ; concluded Professor Clarke.
Posted on Saturday 19 March 2016