DOI: 10.1093/bjs/znad258.687 ISSN:

1012 Evaluation of the ‘Clicky’ Hip in the Diagnosis of Developmental Dysplasia of the Hip (DDH)

M Ross, A Poacher, J Froud, E Morgan, E Carpenter, G Ramage
  • Surgery



Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate the use of a ‘clicky’ hip as an indication for secondary assessment as per the British Society for Children's Orthopaedic Surgery (BSCOS) consensus statement.


Prospective cohort study of all patients born within the catchment area of a single tertiary centre (n = 27,731) all of whom underwent a new-born and 6–8-week examination and ultrasonographic screening of the hip. Multivariate odds ratios, cumulative risk difference, were calculated in relation to DDH (Graf type IIb-IV that required treatment) for those with ‘clicky’ hip as the only abnormality on examination.


The prevalence of pathological DDH that required treatment within our population was 5.1/1000 live births (n = 148). An abnormal examination defined only by the presence of ‘clicky’ hip had a sensitivity of 11.5% [(95%CI6.84 to 14.75) 17/148)] and a positive predictive value of 4.39% (95%CI2.82 to 6.77%) for DDH. The increase in risk of having DDH from having a clicky hip during the 6-8-week examination was 10.1% and odds ratio 3.84 (95%CI2.33 to 6.32) demonstrated a significant association (p<0.001).


This study has evaluated the role of the ‘clicky’ hip in neonatal hip screening. Clearly demonstrating a statistical association with pathological DDH and also providing important information relating to the risk and predicative value of a clicky hip, addressing the principal research need by the BSCOS consensus statement.

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