From the Guidelines
Hip clicks are common findings in newborns, occurring in approximately 5-30% of infants, but only about 1-2% of these clicks represent true developmental dysplasia of the hip (DDH) 1. The incidence of hip clicks and developmental dysplasia of the hip (DDH) is a significant concern in newborns.
Key Findings
- The estimated incidence of DDH is 1.5 to 20 per 1,000 births, depending on the demographics of the study population and the diagnosis and monitoring of teratologic hips from neuromuscular or syndromic causes 1.
- The pathophysiology of DDH is multifactorial and not completely understood, with the two leading causes being laxity induced by maternal hormones and limited in utero hip mobility 1.
- Risk factors for DDH include female gender, breech positioning in utero, and a positive family history, carrying relative risks of 2.5,3.8, and 1.4, respectively 1.
Screening and Diagnosis
- All newborns should be screened for DDH through physical examination, including the Ortolani and Barlow maneuvers, at birth and during well-child visits up to 6 months of age 1.
- A hip click alone without instability is not diagnostic of DDH but warrants follow-up, and if accompanied by risk factors or physical exam findings, further evaluation with ultrasound is recommended at 6 weeks of age, or earlier if the physical exam strongly suggests DDH 1.
- For infants with isolated clicks and no other concerning findings, clinical follow-up without imaging may be appropriate 1.
Treatment and Outcomes
- Early detection and treatment of DDH is crucial, as delayed diagnosis can lead to complications including gait abnormalities, pain, and early-onset osteoarthritis 1.
- Treatment options depend on the age at diagnosis and severity, ranging from Pavlik harness for infants under 6 months to more invasive surgical interventions for older children 1. Therefore, it is essential to prioritize early screening and diagnosis of DDH to prevent long-term complications and improve outcomes for affected infants 1.
From the Research
Incidence of Hip Click and Developmental Dysplasia of the Hip
- The incidence of developmental dysplasia of the hip (DDH) in infants with an isolated hip click is a significant concern, with rates varying from 0% to 28% 2.
- A study found that 26% of patients referred for isolated hip click had sonographic abnormalities, with 19.6% demonstrating physiological immaturity, 1.2% demonstrating moderate sonographic dysplasia, and 5.1% having sonographic findings consistent with severe dysplasia or dislocated hip 2.
- The American Academy of Pediatrics notes that hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States 3.
- Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies 3.
Pavlik Harness Treatment for DDH
- The Pavlik harness is a common treatment for DDH, with studies showing acceptable radiological results in infants 4.
- A study found that the overall short-, mid-, or long-term success rate of Pavlik harness treatment ranges from 45% to 100%, with a commonly reported success rate of over 75% 5.
- However, the failure rate of Pavlik harness treatment can be significant, with factors such as age, gender, laterality, radiological or clinical severity of the initial hip pathology, and parents' compliance influencing the outcome 5.
Screening and Referral for DDH
- The American Academy of Pediatrics recommends newborn and periodic screening for DDH, as it is clinically silent during the first year of life and can be treated more effectively if detected early 3.
- A study recommends screening ultrasound and/or orthopaedic referral for all infants with isolated hip click, as they may have higher rates of dysplasia than previously reported 2.
- However, there is controversy surrounding screening programs and techniques, with little evidence-based literature to support current practice 3.