Interview – Nicole Williams

Paediatric orthopaedic surgeon, South Australia

DDH, Healthy Hips Week, and the modern media environment

I understand much of your recent research has been focused upon developmental dysplasia of the hip – DDH. Can you tell me a little about your latest work and what drew you to the subject in the first place? Have any of the results of your research surprised you?

Our research team recently published a study in the Medical Journal of Australia showing that in South Australia, the number of patients with late diagnosed (after three months of age) developmental dysplasia of the hip (DDH) has risen from one to two per year in 1988 – 1996 to 14 – 15 per year since 2003. Late diagnosed DDH is associated with poorer outcomes than an early diagnosis, with more children requiring surgery, more invasive surgeries required and a greater risk of hip problems, including osteoarthritis, in early adulthood. NSW, WA and TAS have also reported increased numbers of late DDH. Our study identified that babies without traditional risk factors for DDH are more likely to be late diagnosed and rural babies are at particular risk. The research confirmed what we were suspecting anecdotally. We believe we can reverse this trend by improving the standard of physical examination, particularly in rural populations, reminding all clinicians to check all babies carefully, not just those with traditional risk factors, and avoiding childcare practices that are detrimental to hip development, such as swaddling with the legs together.

You worked with the people at Healthy Hips Australia to promote awareness of DDH, particularly through the recent Healthy Hips Week. Can you tell me about your aims and aspirations – and those of the people at Healthy Hips Australia – in pushing that message?

Healthy Hips Australia (HHA) is a charity founded by a mum of two daughters with DDH.  HHA successfully applied to the Commonwealth Department of Health to have 10 – 16 April 2016 designated Healthy Hips Week. The aims of the week were to increase awareness in the medical fraternity and general public of the increased numbers of late DDH, inform of the signs of DDH and risk factors, and promote ‘hip-healthy’ childcare practices. The stated mission of HHA is to increase the availability and accessibility of resources, education and support for people working with and impacted by hip dysplasia. Their website contains DDH resources for professionals and there is a Facebook page for parents to seek support and access information about caring for infants and children who are undergoing treatment for DDH.

HHA Logo crop

With increasingly fluid, rapid and accessible forms of communication, and the surge in popularity of ‘science advocate’ pages and personalities on social media, do you see the role of physicians and medical researchers shifting in terms of communication with the broader public?

Scientific research was traditionally published in subscription-only journals and unable to be accessed by the broader public. Occasionally research findings were reported (often inaccurately) in newspapers and on television. In contrast, members of the public were able to access online a large amount of unregulated ‘medical’ information of varying accuracy. Fortunately, there has been a shift, and an increasing amount of scientific information is now accessible online. Websites of hospitals and other medical organisations now commonly provide summarised and referenced information for patients and families. Although many online readers will continue to be influenced by well-promoted but non-scientific sources, others will preferentially access reputable sources. Physicians and medical researchers should contribute to the dissemination of important information through these channels, not just in medical journals.

"Physicians and medical researchers should contribute to the dissemination of important information through these channels, not just in medical journals."

I noted that in some media surrounding Healthy Hips Week, news outlets were referring to ‘clicky hips’ as an alternative to ‘developmental dysplasia of the hip’. In an environment where one rather prominent social media personality advocates against eating anything she can’t pronounce, do you think there are particular challenges around advocacy on issues as ‘specific’ and little-known as DDH?

I don’t like the term ‘clicky hips’. The vast majority of hip clicks are self-resolving and come from structures outside the hip joint. Multiple studies have shown no association between a hip click and DDH. I’ve not read Ortolani’s original paper (published in Italian) describing his test for newborn hip dislocations, but it has been suggested that he described a ‘clunk’ that was mistranslated to ‘click’. ‘Clicky hips’ is, however, a simple term that resonates with the public and many clinicians. People rapidly lose interest if you have to explain in detail exactly what condition you are promoting awareness of.  DDH is hard to explain simply, as it is a spectrum of conditions, with risk factors rather than a single cause and variable treatments and outcomes.