A clicky hip carried nearly five times the odds of treatment-requiring DDH

Design

Retrospective analysis of prospectively collected screening registry data

Population

42,338 live births in one UK tertiary catchment, 2016-2023

Primary outcome

Pathological DDH requiring treatment

Effect

Clicky hip aOR 4.68 (95% CI 3.11 to 7.03); PPV 3.56%; number needed to screen 26

Using prospectively collected registry data from one UK tertiary centre's catchment, researchers followed 42,338 infants born between 2016 and 2023 through a selective screening programme: clinical examination at birth and six to eight weeks, with ultrasound for risk factors or abnormal findings, including a clicky hip.

Pathological DDH needing treatment occurred in 5.8 per 1,000 births. Of 1,125 infants with a documented clicky hip, 40 (3.6%) needed treatment. After adjustment, a clicky hip was associated with DDH (adjusted OR 4.68, 95% CI 3.11 to 7.03). Within the programme, about 26 infants with a clicky hip would need an ultrasound to find one who needed treatment.

A clicky hip has often been dismissed as a benign ligamentous click. This analysis suggests it deserves a scan, although the authors note that selective screening itself shapes who is found, and they call for prospective testing before changing pathways. In Indian practice, where universal ultrasound is rarely available and late presentation is common, a cheap clinical flag that improves targeting is worth taking seriously.

• Record a clicky hip at the newborn and six-to-eight-week checks rather than dismissing it.
• Consider hip ultrasound for an infant with a documented clicky hip.
• Continue to refer for breech presentation, family history and an abnormal Barlow or Ortolani test.
• Expect most clicky hips to be normal: about 1 in 26 needed treatment in this cohort.

Why it matters

It challenges the habit of reassuring parents about a hip click without imaging.

Don't overread it

Selective screening means only some infants were scanned; the association may be inflated, and the authors call for prospective evaluation.

The statistics, in plain English

An adjusted odds ratio of 4.68 means a clicky hip was linked to nearly five times the odds of DDH needing treatment. The positive predictive value of 3.6% means about 96 of every 100 clicky hips were fine. Number needed to screen of 26 means 26 scans to find one case.

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