By Virginia Winder

A life of pain could've been avoided if Frances Moral's hips had been checked as a baby.

But Frances was born in 1958 - six years before Victor Hadlow began his hip-check mission in New Plymouth.

Since 1964, every baby born in Taranaki Base Hospital's maternity unit has been tested by an orthopaedic surgeon. Only two babies have been missed, but they were still diagnosed early in their lives and are progressing well.

Frances was not one of those.

"Believe it or not, I was not diagnosed until my early 20s," she says.

However, there had been many signs that something was wrong. When Frances (nee Hall) began to walk, a Plunket nurse who lived across the road said: "Look at the way that girl's walking - that's bizarre."

Hurdles of bendy legs

As she grew up, Frances was prone to tripping and falling over. Sometimes her legs would simply give way.

She could also bend her legs at strange angles. At ballet, she was able to do all the difficult movements, but lacked the control to stay in position.

She was also a gun at hurdling. "Because I could fold my legs up, like the under carriage of an aeroplane."

At 14, the pain began and Frances' mother sent the teenager to a chiropractor, but the underlying problem wasn't discovered.

Nearly a decade later, the young woman went to the doctor in desperation, saying: "There is something terribly wrong with either my back or my legs."

First up, the doctor sent her for x-rays and diagnosed her with congenital hip displacement - the exact problem Victor Hadlow's hip checks are designed to catch and cure.

Facing endless surgery

"It was a relief in a way," Frances says, "because I imagined something horrible like a tumour or one of those paralysing diseases."

In 1988, when she was 30, Frances had a femoral osteotomy. The two-operation procedure was performed by Pat Medlicott (now retired) and Victor Hadlow.

Frances had to have a year off work from the Inland Revenue Department (IRD) to recover from what she calls a "hideous operation".

"They broke my femur and reconnected the top of the femur into the hip socket. That bought me 15 years until the hip replacement I had last year (2003)," she says.

That required two operations by orthopaedic surgeon Julian Stoddart. The process only fixed one hip, so Frances faces more major surgery to replace the other one.

During the latest ordeal, her husband, Aarun, was able to take three months off his job at the IRD to care for his wife and their two children, Bridget (born in 1995) and Hayden (1998). "When I worked for the IRD, they were 100% supportive. It's still following up. There was no question that Aarun needed that time - it was for family and it was important."

Finding inner strength

Her husband, family and friends have all been invaluable in assisting her recoveries.

"After the operations I have had, I find it's quite easy to feel quite down," she says.

"You have to claw back to stop it overtaking. You are not going to get right physically, unless you have the right mental attitude and that can be quite hard."

Right now Frances is the best she's been for years.

She is able to do aqua jogging and exercycling to keep fit. "It's a case of use it or lose it."

With this short window of physical wellbeing come simple pleasures, like being able to sit on the beach to watch her family gambol over rock pools; like take the five-minute walk to see Dawson Falls on Mount Taranaki.

Normally, Frances can't manage these activities and has to sit in the car waiting while her Aarun, Bridget and Hayden have adventures. 

Gamble of having children

Even having children was a major risk for Frances. Pregnancy brought fears of further physical problems and worries about her babies. "In the last trimester of both pregnancies I was immobile," she says.

"I always knew it was going to be a gamble. There was a chance I would come out of the delivery suite and into the operating theatre."

Luckily that didn't happen, but giving birth to Bridget the natural way did cause Frances great problems. "It took me ages to become mobile again."

With Hayden, she had a caesarian and a much quicker recovery.

Looking back at those early days with her babies, Frances sees them as hugely positive times because all she could do was breastfeed and cuddle her babies.

"It was a very bonding time."

Double check for daughter

Hip problems run through Frances' family - her sister has the same condition, their mother has had three hip replacements and an aunt also suffers.

Despite this, Bridget and Hayden came out perfect.

It took some convincing for Frances to believe the findings. "I sent Bridget back for two checks," she says.

She had prepared herself for what she believed was inevitable - her babies would need to spend six to eight weeks in a rubber splint to completely cure any hip problems.

Frances was determined that that early intervention would happen.

Get the message

"If you are the mother of a new-born, it's very difficult for you to see the repercussions of not having a hip check. It's short term for the long term."

Her own life reflects the bigger picture.

And she's got a message for those who can't see it: "If you want to inflict a life of operations, pain, physical disability and strong medications for the rest of someone's life - then don't do a hip check."

Despite spending years on crutches, a short time in a wheelchair and coping with never-ending pain, Frances has continued to have a full life. She is the Parent's Centre regional co-ordinator for Taranaki and was involved in kindergarten activities and now school. She is also involved in the National Council of Women.

"I don't think it's stopped me from doing what I wanted to do - I haven't let it."

Testing our babies

Since 1964, Victor has dedicated himself to ensuring every baby born in Taranaki Base Hospital's maternity unit has been, and will continue to be, tested for displaced hips.

He is particularly prickly on the subject of who should do the checks - nurses, doctors or orthopaedic surgeons - and is adamant it should be the latter.

"It's a very subtle finding. It's not obvious and, unless you're very experienced, and are doing several hundred examinations a year, you'd tend to miss it," he says.

"You also need to be knowledgeable in the anatomy of this part of the body. In other words, you need to have operated on it and seen exactly what the ball and socket look like."

For Victor, finding a faulty hip is almost like having a sixth sense, an inner eye.

These days the divining hands belong Victor's son, Simon, also an orthopaedic surgeon, and fellow surgeon Tim Lynskey.

Meticulous records show that about 15 in every 1000 babies will reveal a problem hip when checked during the first seven days after birth. Of those picked up, only two will suffer future disabilities if left untreated. A further one or two may have minor problems early on with hips slipping in and out of sockets.

Splint for problem hips

Victor says it's impossible to tell which of these babies will get better without early intervention.

"So you're stuck," he says. "You have to put a splint on 15 babies in a thousand, and that will cover the two who would get in strife."

For six to eight weeks, an unwieldy rubber splint spreads the baby's legs, allowing the hip sockets to form and ligaments to tighten. This makes it difficult for parents to cuddle their new-born properly, while breast-feeding and changing nappies may be awkward.

But the results are worth it.

During the past 40 years, only two screened cases of congenital hip dysplasia (CHD) have been missed in New Plymouth and both these were overlooked by an examiner in the learning phase of training.

Victor says the two who slipped through were discovered at 15 months and 18 months and "are at present quite good".

A third child was diagnosed with a displaced hip, but after a second check at seven days a surgeon believed the hip had settled down. However, when re-examined at six months, the child's hip was clearly dislocated.

"But there are certainly 78 who don't even know they would've ever had a problem," Victor says.

Focus on females

He is mostly talking about girls.

In his 21-year report, covering the period from 1964 to 1985, Victor states: "Ten times more female than male babies were affected."

And hip instability is nearly five times as common in breech babies - those born bottom or feet first rather than head first.

While the exact cause of the dysplasia isn't certain, it's likely to stem from the pregnant mother, who produces a hormone called relaxin. As it implies, this chemical allows the mother's muscles and joints to relax in readiness for giving birth.

"Unfortunately, it passes through the placenta so that the child also gets excessive female hormone," Victor says.

"So what happens then is the child is born with a hip that can slip in and out of its socket. The second effect of this is that if the hip is not in its socket at birth, before birth or just after birth, the socket doesn't develop. So they have a double whammy, as you might say."

Chance for 100% normality

But there is hope for those found.

"I must stress that this is the only condition in my field where you can do something for someone who is going to be normal," he says.

Victor learnt the technique from Swedish doctor Julius von Rosen, who spoke at a Royal Society of Medicine seminar in England during the early 1960s.

At the time, Victor was doing part of his four-year fellowship in surgery at London's Royal National Orthopaedic Hospital, where all the cases of children with dislocation of the hip were cared for in one ward.

"I worked in that ward (under surgeon David Trevor) and I saw all these lovely little girls of two or three have operation after operation after operation to try and correct this terrible disability."

Then he found out about von Rosen's early intervention method. "I heard his lecture and it inspired me because I found it really stressful to operate on these little girls, knowing that the end result of the operation wasn't going to be perfect."

That's why Victor sees the hip check regime as so important.

"The results reported in this paper demonstrate (as have many others) that the method can be highly successful. It is therefore necessary to examine the reasons for the controversial opinions, which cause confusion and lead to neglect of the examination and many unnecessarily bad results," the 21-year report says.

In other words, blame the tester not the test.

Smaill beginnings

While Victor continues to preach the pluses of hip checks, he wasn't the New Zealand pioneer. That credit goes to his friend, Graeme Smaill, who began them at Wellington in 1963.

However, Graeme died soon after, leaving Victor to blaze the trail.

In New Plymouth, the young orthopaedic surgeon had help from obstetrician Bob Davie, and maternity matron Hyacinth Henderson.

"She was also supportive and so she would always supply me with staff," Victor says of the nursing sister. "Now that mightn't  sound much, but it meant that the poor old nurses would have to collect say 20 babies in a room, take off their naps for me, have them ready, give them to me, and then put their naps on."

Victor says he swooped in during his lunch hour, where the newborns were all set up. "With the assistance and huge co-operation of the nursing staff, I was able to achieve this. And I take off my hat to them."

Seeing in black and white

Simon Hadlow says his father has a way of convincing people to listen.

"He has the ability to crystallise one side of an argument and present it. He's a very didactic person. Things are very black and white," says Simon, a details man. "Once you get deeper into answers, you find there are many shades of grey."

But Simon says his dad is a "very sound practitioner" and an innovative, pioneering surgeon. "His procedures have stood the test of time. That's very true of hip screening."

Tim Lynskey has been doing hip tests alongside a Hadlow since 1984.

The New Plymouth orthopaedic surgeon believes the checks need to be done by a specialist. "The further you get away from having to deal with the problem, if there is one, the less accurate you are."

In other words, if hip anomalies aren't picked up, Tim or another Taranaki bone surgeon will be the ones to fix it in the future.

Saving pain and suffering

Orthopaedic surgeon Alastair Grant moved to New Plymouth in 1974 and immediately joined the Victor-led hip-check team.

"It's been extraordinarily successful. It's really saved an enormous amount of pain and disability. It's a very effective public health measure. It's so simple, cheap and hugely effective," he says.

"But a lot of caution is required because you frequently see successful public health measures containing the seeds of their own destruction."

He explains this by comparing New Plymouth's hip-check programme with ongoing vaccination campaigns: "If all the mothers ever saw a tetanus or diphtheria death, they would not hesitate (in getting their children immunised).

Area of controversy

"When no one has seen the results of a CDH child, the incentives diminish. I do recall on more than one occasion we had to justify the minimal expense that this (the testing) was costing."

Alastair, who now lives in Wellington, says not all medical people believe the hip-test regime is effective.

"It's been an area of controversy for some time. Nothing is cut and dried in medicine - everything is worth an argument. You are dealing with biology here."

Alastair is also wary of passing judgement on other places that don't have strict hip-check programmes carried out by orthopaedic surgeons. "It would be presumptuous of me - all centres are different, but it may be possible now."

He points out that Taranaki has always had the highest number of bone specialists per head of population in New Zealand. This was done deliberately: "Because we wanted to provide a comprehensive service and also have a lifestyle. We did not want to work atrocious hours."

'Best results in world'

That also meant there were enough surgeons to be able to make sure that hip checks could be carried out twice weekly at New Plymouth and once a week at Stratford and Hawera. Testing on babies in those out-lying regions of Taranaki began in the 1970s when more surgeons were employed.

Because of this, the scientific data relating to the programme only includes New Plymouth.

The parting words of both Alastair Grant and Tim Lynskey refer to Victor's massive efforts in ensuring the children of Taranaki can walk and move freely, without pain or disability.

"I cannot give credit enough to Victor Hadlow for setting up this programme, maintaining it, following it up and publishing the results in international literature," Alastair says.

Tim is even more expansive about Victor's "contentious" campaign. "Time has proved that he's correct. They are among the best results in the world, if not the best, for this problem."

For Victor, the proof is out there on the streets. "I often look at the young girls walking round the street and think, 'this is good, none of them are limping'," he smiles.