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Is 'clicky hip' a risk factor in developmental dysplasia of the hip?
Insights
Isolated hip clicks in infants beyond six weeks are rarely predictive of developmental dysplasia of the hip (DDH). Further investigation is recommended when clinical doubt persists regarding hip click diagnosis.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
Background:
- The prognostic significance of a 'clicky hip' for developmental dysplasia of the hip (DDH) remains debated.
- This study investigates isolated hip clicks as a predictor for DDH.
Purpose of the Study:
- To evaluate the predictive value of isolated hip clicks for developmental dysplasia of the hip (DDH).
Main Methods:
- Prospective follow-up of 235 infants with persistent hip clicks beyond six weeks of age.
- Focus on 176 infants with isolated hip clicks and no additional risk factors.
Main Results:
- Seven out of 176 infants (3.9%) showed initial abnormal ultrasound findings (Graf classification IIa, IIb, IIc).
- All infants with isolated hip clicks ultimately presented with normal clinical and radiographic hip examinations.
Conclusions:
- Isolated hip clicks beyond six weeks of age are infrequently predictive of DDH.
- Screening for DDH may identify rare cases, but including hip clicks as a sole risk factor is not consistently reproducible.
- Referral to experienced orthopedic surgeons or radiologists is advised for cases with persistent doubt.
Background:
The role of the 'clicky hip' symptom as a prognostic predictor of developmental dysplasia of hip (DDH) is controversial. We aim to study the role of isolated hip clicks as a prognostic predictor of DDH.
Material And Methods:
235 babies with persisting or referred with clicky hip beyond six weeks of age were prospectively followed up to note the incidence of DDH. Of these 176 babies were referred for a hip click without additional risk factors.
Results:
7 out of 176 cases (4-IIa, 2-IIb, 1-IIc) had initial abnormal ultrasound examination based on Graf classification. However, all babies with isolated hip clicks eventually had normal hips on clinical and radiographic examination.
Discussion:
While screening of babies with clicky hips does help in diagnosing the odd case of DDH this is not. consistently reproducible. Modifying the targeted ultrasound screening by including clicky hip as a risk factor will not reduce the incidence of missed cases. Isolated clicks in the hip joint beyond six weeks age are rarely a predictor of DDH. However when in doubt such cases should be referred to be reviewed by an orthopaedic surgeon or a radiologist experienced in hip ultrasound.
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