A clicky hip is a common referral for clinical and sonographic
screening for developmental dysplasia of the hip (DDH). There is
controversy regarding whether it represents a true risk factor for
pathological DDH. Therefore a 20-year prospective, longitudinal,
observational study was undertaken to assess the relationship between
the presence of a neonatal clicky hip and pathological DDH. A total of 362 infants from 1997 to 2016 were referred with clicky
hips to our ‘one-stop’ 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.Aims
Patients and Methods
This 20-year prospective longitudinal observational study aims to determine the incidence of pathological developmental dysplasia of the hip (DDH) in children referred with clicky hips and define the risk posed to inform neonatal hip screening programmes including the role of ultrasound. 355 children from 1997 to 2016 were referred with clicky hips to our “one stop” paediatric hip clinic under the local neonatal hip screening programme. Hips were assessed clinically for instability and by ultrasound using a simplified Graf classification. Dislocated or dislocatable hips were classed as Graf type IV.Purpose
Method
There is concern that the positive predictive value (PPV) of neonatal screening for instability may have deteriorated over recent years, this study aims to evaluate this. This is a prospective observational longitudinal study from 2012 – 2016. Patients that were referred from paediatric neonatal screening with hip instability (Ortolani / Barlow positive, clunks) were identified and underwent ultrasound and clinical examination in the one stop hip clinic by the senior author. Referrals were taken from a range of screeners from paediatric doctors to midwives and advanced neonatal practitioners. Syndromic or neurological dislocated hips were excluded. The outcome measures were the presence of a subluxated / dislocated hip on ultrasound as per Graf and Harcke classification and a positive provocative manoeuvre on examination. This allowed a PPV to be evaluated for both ultrasound and clinical examination.Purpose
Method
