of the Hips
Malcolm Battin, Sue Stott & Charmaine Lo
These guidelines are based on the following information and known resource
Approximately 1 in 100 babies will have hip instability immediately after
birth. However, for the majority of babies this hip instability will resolve in
the first few weeks of life, leaving an incidence of DDH of 1-2 per 1000.
Detection of DDH is not always easy and all screening programmes have an
incidence of late presentations of DDH. Screening is thought to reduce the
incidence of “late” DDH by about 50%.
All babies should be examined in the neonatal unit for hip instability and
action taken as below.
Babies with definite DDH i.e. a dislocated hip that is either reducible or
- If a baby has a dislocated hip confirmed on repeat examination by a
medical examiner, then this should be discussed with the paediatric
orthopaedic registrar and a written referral made to the Orthopaedic
Department with the name of the GP. The consultant on call will decide
whether they wish to see the baby in the unit or at an early time in their
Babies with “soft signs” of DDH i.e. clicky hips or asymmetric skin creases:
- Many babies have clicky hips at birth or in the first few months. The
great majority have normal hip X-rays at 4 months of age.
- Therefore, babies with clicky hips or asymmetric thigh creases should be
discharged back to the GP with a request that the GP re-checks the hips at
the regular baby checks AND arranges an AP pelvis X-ray at 4-6 months of age
with a copy of the report to the Starship Hospital Orthopaedic Department.
- These X-rays can be arranged either through the public or private
Babies with risk factors for DDH but no clinical signs of instability:
Risk factors are defined as below:
- Breech position/ delivery
- Family history of DDH in close relative
- Babies with other orthopaedic problems (eg. metatarsus adductus or
calcaneovalgus foot deformity) or neuromuscular problems
- Discharge child back to GP with a request that the GP re-checks the hips
at the regular baby checks AND arranges as AP pelvis X-ray at 4-6 months of
age with a copy of the report to the Starship Hospital Orthopaedic
- These X-rays can be ordered through Starship radiology or via the
Link to GP letter