Hip click in the neonate: Should I be concerned?

Developmental dysplasia of the hip (DDH) requires precise evaluation and rapid treatment/referral to specialists to optimize results. The incidence of DDH ranges between 4/1,000 and 133/1,000 newborns depending on patient risk factors (female gender, breech birth, and family history). Multiple associations have been identified including metatarsus adductus, oligohydramnios, and muscular torticollis. Classic physical examination results are well known by pediatricians, but can be difficult to elicit. Ultrasound screening is a useful test in defining early dysplasia and dislocation, but can generate misleading results if used inappropriately. Early ultrasound is useful for the identification of unstable hips and discerning treatment. High rates of ultrasound abnormalities have been identified in the early neonatal period, most of which have been shown to spontaneously improve. Ortolani/Barlow negative hips are best evaluated at age 6 weeks if continued concern is present. Treatment with the Pavlik harness or an abduction splint is well known to have excellent outcomes, but not without risk.