Prof Alex Aarvold is a Consultant in Children’s Orthopaedic Surgery at University Hospital Southampton (UHS) and holder of a Research Leaders Programme (RLP) award.

He is also an Honorary Professor of Children’s Orthopaedic Surgery at the University of Southampton. His research focuses on improving outcomes for children with hip dysplasia.

Preventing lifelong pain and disability

Hip dysplasia is a condition where the ball and socket joint of the hip does not properly form in babies and young children.

The socket is too shallow, meaning the top of the thigh bone is only held loosely or not connected at all. It can affect either one or both hips.

It is important to spot it early, when it is easiest to treat. In the UK, a doctor, midwife or nurse does a ‘hip check’ soon after babies are born, and again when they are six to eight weeks old. This involves wiggling the baby’s legs to check if the hip feels unstable. If they have concerns, they send the baby for a scan to look at the hip bones.

However, Alex’s research has shown that the hip check is extremely bad at detecting problems. This means hundreds of babies every year in the UK are not referred for a scan, miss out on early simple treatment, and may require surgery that could have been prevented.

Without treatment at a young age, hip dysplasia can lead to lifelong pain and disability. It can cause problems with walking, running and jumping, and osteoarthritis in the hip and back.

“If someone with hip dysplasia is not treated, they are likely to get pain in their teenage years, then early arthritis and a hip replacement in early adulthood,” explains Alex.

“When that wears out, they will need a revision hip replacement, possibly in their thirties or forties. They may then need a second revision hip replacement in their fifties or sixties. The UK screening programme is not good enough, and we need to find ways of improving it.”

Building on an incredible legacy

Alex’s work builds on a long history of hip dysplasia research in Southampton. This was led by Professor Nicholas Clarke and John Wilkinson before him.

“There’s an incredible legacy of research here, on the back of these two great people,” he says.

Alex worked with Professor Clarke to develop a simpler, quicker surgical technique to treat babies with hip dysplasia. Alex is finishing the analysis of these results, and intends to publish them in the next few months.

He now plans to use his RLP award to take this research a step further. He will use it to develop a solid grant application that will allow him to run large-scale national and international trials.

It would be extremely difficult to do this, he says, without the dedicated time the RLP provides.

“The RLP has given me this opportunity. It’s amazing.”

Which hips to treat?

Currently, it is unclear whether babies with mild or ‘borderline’ hip dysplasia require treatment.

Alex intends to use his RLP award to determine where the cutoff for which hips to treat should be. He will work closely with Professor Daniel Perry at Alder Hey Children's Hospital in Liverpool.

The results of this research will help to guide the screening and treatment of these babies.

Investigating the causes

Alex also intends to use his award to better understand the underlying causes of hip dysplasia.

As part of his orthopaedic training in the Wessex region, Alex worked in Richard Oreffo’s tissue engineering laboratory. He will now work with this team again to understand the biochemical processing involved in hip dysplasia.

He wants to see if hip dysplasia might be caused by a lack of a certain nutrient in pregnancy.

If so, this opens up the possibility of mothers taking a supplement in pregnancy to prevent hip dysplasia. This would be similar to taking folic acid supplements to prevent spina bifida.

Alex intends to use the networking opportunities provided by the RLP to form new collaborations with nutrition experts in the NIHR Southampton Biomedical Research Centre.

If he can identify a nutritional cause, this would be just the start of a much bigger piece of work.

“If a preventative strategy could be developed for hip dysplasia,” he says, “which is an incredibly common disorder and incredibly disabling if untreated, that would be huge worldwide.”