Hip Dysplasia

The evaluation of a newborn for hip dysplasia is an important part of the initial physical exam.  Frequently the "clunk" that is felt when an unstable hip dislocates out of, or reduces back into, the hip socket is significant enough that the first-time examiner wonders if they have injured the baby.  The difficulty lies in the fact that not all dysplasia presents with an abnormal exam at birth, so repeat exams and screening for high risk infants are important.  Because a positive family history impacts the risk for the infant, family history of hip problems in childhood should specifically be sought. 

Background Information

Assessing Risk

Physical Examination

Screening and Management Recommendations

AAP Clinical Practice Guideline

• Incidence influenced by genetics, race, diagnostic criteria, experience and training of the examiner, age of the child
• Increased risk to subsequent children in presence of diagnosed dislocation  (6% risk with healthy parents and an affected child, 12% risk with an affected parent, and 36% risk with an affected parent and 1 affected child
• Incidence of instability 1 in 100 newborns, incidence of dislocation 1 to 1.5     per 1000
• Incidence of DDH is higher in girls
• Left hip is involved 3 times more than the right hip

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• Family History (newborn risk for boys of 9.4/1000 and for girls, 44/1000)
• Female Sex (newborn risk of 19/1000)
• Breech Position (newborn risk for boys of 26/1000 and for girls, 120/1000)

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• The Ortolani elicits the sensation of the already dislocated hip reducing: a "clunk" is felt as the dislocated femoral head reduces into the acetabulum.
• The Barlow detects the unstable hip dislocating from the acetabulum: a palpable clunk or sensation of movement is felt as the femoral head exits the acetabulum posteriorly.
• May not be positive after 8-12 weeks REGARDLESS of the status of the  femoral head
• High pitched clicks are generally considered inconsequential

• Positive Ortolani/Barlow
• Equivocal Ortolani/Barlow (soft click or mild asymmetry)
• Negative Ortolani/Barlow with risk factors
• Negative Ortolani/Barlow without risk factors

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If a positive Ortolani or Barlow sign is found at newborn examination: 

• Consult Peds Ortho
• Ultrasound or x-ray not recommended
• Use of triple diapers during the newborn period is not recommended because it delays appropriate treatment

If the examination at birth is "equivocally" positive:

• Follow-up hip examination in 2 weeks
• If positive at 2 weeks, refer to Peds Ortho
• If equivocal at 2 weeks, consider referral or order ultrasound at 3-4 weeks

If the examination at birth is negative:

• Consider risk factors
• Any one risk factor present, reevaluate at 2 weeks of age, then according to the periodicity schedule
• If 2 greatest risk factors both present-- female and breech—screening ultrasound at 6 weeks OR screening radiographs at 4 months is recommended

If the examination at birth is negative and no risk factors:

• Hips should be evaluated according to regular periodicity schedule

 

ABurgosMD,  reviewed 5-06  

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