- Design
- Retrospective analysis of prospectively collected screening registry data
- Population
- 42,338 live births in a UK selective screening programme, 2016-2023
- Primary outcome
- Developmental dysplasia of the hip requiring treatment
- Effect
- Clicky hip aOR 4.68 (95% CI 3.11-7.03); PPV 3.56%; number needed to screen 26
A UK tertiary centre analysed registry data for all 42,338 live births in its catchment from 2016 to 2023 (Bone & Joint Journal, 1 October 2026). Infants were examined at birth and at six to eight weeks, and ultrasound was offered for risk factors or abnormal examination findings, including a clicky hip.
Developmental dysplasia of the hip requiring treatment occurred in 245 infants (5.8 per 1,000). A clicky hip was documented in 1,125, of whom 40 (3.56%) needed treatment. After adjustment, a clicky hip was associated with treated dysplasia (OR 4.68, 95% CI 3.11-7.03); the number needed to screen was 26.
A click has long been taught as benign. These data suggest an isolated documented click carries enough risk to warrant ultrasound within a selective programme, though the authors call for prospective confirmation because not every infant was scanned.
- Do not dismiss a documented clicky hip at the newborn or 6-8 week check without considering ultrasound.
- Record the examination finding clearly; it was the trigger for scanning in this programme.
- Continue to scan infants with breech presentation or a family history, as current pathways require.
- Explain to parents that most clicky hips are normal, but a scan rules out dysplasia.
Why it matters
It challenges the teaching that a click without instability can be ignored.
Don't overread it
Only infants with risk factors or abnormal findings were scanned, so the true rate of dysplasia in infants without a click is uncertain.
The statistics, in plain English
Positive predictive value 3.56% means about 1 in 28 infants with a click needed treatment. Number needed to screen of 26 means scanning about 26 clicky hips finds one case.
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