An isolated clicky hip carried nearly five-fold odds of dysplasia needing treatment

Design

Retrospective analysis of prospectively collected screening registry data

Population

42,338 live births in one UK catchment, 2016 to 2023

Primary outcome

Developmental dysplasia of the hip needing treatment

Effect

Clicky hip adjusted OR 4.68 (3.11 to 7.03); PPV 3.56%; number needed to screen 26

This study analysed registry data for all 42,338 live births in one UK tertiary centre's catchment from 2016 to 2023, within a selective screening programme. Infants were examined at birth and at six to eight weeks, and ultrasound was offered for primary risk factors or abnormal findings, including a clicky hip. A consensus statement from British children's orthopaedic surgeons had previously flagged the predictive value of a clicky hip as uncertain.

Dysplasia needing treatment was found in 245 infants, 5.8 per 1,000 births. A clicky hip was recorded in 1,125, of whom 40 (3.56%) needed treatment. After adjustment, a clicky hip was independently associated with treatable dysplasia (adjusted OR 4.68, 95% CI 3.11 to 7.03). Within the programme the risk difference was 3.86%, and 26 clicky hips needed scanning to find one case.

Many services stopped referring isolated clicky hips on the view that they are benign ligament clicks. These data suggest that view misses cases, at a cost of one scan per 26 infants. The authors call for prospective evaluation, because infants with a click were more likely to be scanned, which can inflate the association. Until that comes, referral for ultrasound is a reasonable choice where scanning capacity allows.

• Document a clicky hip clearly at the newborn and six-to-eight-week checks.
• Consider ultrasound referral for an isolated clicky hip where local capacity allows.
• Keep referring for primary risk factors and an unstable hip as current programmes require.
• Tell parents that most clicky hips are normal, while about one in 28 needed treatment here.
• Follow local screening policy, which has not yet changed on this evidence.

Why it matters

Dismissing a clicky hip as benign may delay diagnosis in a minority who would have been treated without surgery.

Don't overread it

This is a single-centre retrospective analysis; national screening guidance has not changed.

The statistics, in plain English

An adjusted odds ratio of 4.68 means nearly five times the odds of treatable dysplasia, with an interval well above 1.0. A number needed to screen of 26 means 26 clicky-hip scans for each case found. Because a click made scanning more likely, some milder cases among infants without a click may have gone undetected, which can exaggerate the association.

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