Rise in late diagnosed DDH in Australia - What are we doing about it?
Recent research out of South Australia published, in April 2016, in the Medical Journal of Australia, about the increase in late diagnosed developmental dysplasia of the hip sparked a flurry of media interest in the form of a swaddling warning. This isn't the first swaddling warning to be issued in relation to hip dysplasia and it won't be the last.
Is there more to this research beyond a swaddling warning, and should we be doing something as a country to address this worrying trend?
Yes and yes!
As the title of the research suggests, the major focus of the article is about a rise in late diagnosed developmental dysplasia of the hip (DDH), not only in South Australia but nationally, with New South Wales experiencing a massive ten-fold increase in DDH diagnosed in walking aged children.
Food For Thought:
- The researchers labelled late diagnosed DDH a significant public health issue. Why?
- Lower success of treatment
- Higher rates of surgery
- Increased complications (for example avascular necrosis)
- Increased cost of health-care (hospital admission and need for general anaesthesia)
- Individual toll of major operative procedures
- Breech birth was found to be a 'protective factor' in the cases analysed, with breech babies 25% less likely to be late diagnosed than those that were cephalic presentation (head down).
- Babies born in rural hospitals were 2.5 times more likely to be late diagnosed than those born in a metropolitan public hospital.
- A mother's second born child was 1.7 times more likely to be late diagnosed than her first born (where the first born didn't have DDH). This is a reminder than DDH can occur in any child and late diagnosis is more likely in those without the 'traditional' risk factors.
- The majority of late diagnoses are occurring between 3-6mths of age which highlights the importance of the the ongoing clinical (physical) examinations until competent walking is achieved.
- There is an ever growing amount of global evidence for the negative effect of wrapping/swaddling on hip development in at-risk babies.
Take Home Message:
More education and awareness is needed to reverse this worrying trend, as despite ongoing clinical (physical) screening programs occurring late diagnosis of DDH has risen.
With 8 babies a day being diagnosed with DDH in Australia, and 185 total hip replacements being performed on adults under 55 in Australia, each year, due to hip dysplasia the time is now for making a change to hip dysplasia awareness and education in Australia.
Healthy Hips Australia (HHA):
- empowers parents to start a conversation with their child’s health professional about their hip health.
- encourages everyone to know of the condition, its risk factors and potential signs to facilitate early diagnosis.
- The percentage of parents feeling uninformed about their child’s condition after diagnosis has improved from 79.5% down to 54% since HHA began but there is still work to be done in this respect.
- Parental awareness for the condition prior to diagnosis has also improved from 52 to 57% since HHA began but not by as much as we would like.
Healthy Hips Australia is reliant on community donations and fundraising as we are a volunteer run not-for-profit organisation that is not government funded.
References for information available here.
Written: May 2016. Revised 1 April 2019.
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. Every effort is made to ensure this information is up to date, accurate and easy to understand. Healthy Hips Australia accepts no responsibility for any inaccuracies, information perceived as misleading. This can be reproduce with acknowledgement to Healthy Hips Australia. Handouts are available to download free of charge at www.healthyhipsaustralia.org.au