Congenital Hip Dysplasia – how useful is the “click”?

February 2018, Dr Chee L Khoo

Congenital hip dysplasia (CDH)  is a common fear when we examine newborns. A clicky hip is a common reason for further investigations. CDH is actually not very common but how often does a clicky hip lead to a diagnosis of CDH? In other words, how useful is the “click”?

A 20-year prospective, longitudinal, observational study was undertaken to assess the relationship between the presence of a neonatal clicky hip and pathological CDH.

Between 1997 and 2016, a total of 362 infants with clicky hips were referred to a paediatric hip screening clinic. Hips were assessed clinically for instability and by ultrasound imaging using a simplified Graf/Harcke classification. Dislocated or dislocatable hips were classified as Graf Type IV hips.

Of the 362 infants, 351 (97%) had Graf Type 1 (i.e normal) hips which require no treatment. 9 infants (2.5%) had Graf Type 2 hips but all resolved on follow up scans. Only 1 had Graf Type 3 hip dysplasia and only one had an irreducible hip. Now, both of these infants had unilateral limited hip abduction.

The study concluded that “Most clicky hips required no treatment other than reassurance to parents. Clicky hips with a normal hip examination should be considered a variant of normal childhood and not a risk factor for DDH (aka CDH) However, an abnormal hip examination including unilateral limited hip abduction should prompt urgent further investigations.

Access the abstract here


K. Nie, S. Rymaruk, R. W. Paton. Clicky hip alone is not a true risk factor for developmental dysplasia of the hip. Bone Joint J 2017;99-B:1533–6.