Children with innocent hip clicks are often referred to orthopedic surgeons by pediatricians or anxious parents. This is sometimes necessary to evaluate the possibility of hip dysplasia. However, high pitched clicks are usually normal compared to a sensation of movement where the hip slides in and out of the joint. That sliding can be felt by the examiner, but rarely produces a sound. After the click has been evaluated and determined to be normal, the question remains whether the child needs to be seen again in the future.
A previous study from Queen Alexandra hospital, Portsmouth, UK, studied the outcomes of innocent infant hip clicks.
The authors identified infants whose sole risk factor for developmental dysplasia of the hip was a soft tissue hip click. All patients had a normal ultrasound scan on initial assessment. A follow-up 6-month pelvis x-ray was assessed in all cases. The well-established measurements for mild dysplasia (acetabular index, position of femoral ossific nucleus and Shenton’s line) were measured.
All measurements for each of the 171 infants were within the normal ranges. The authors noted that all infants with hip clicks and normal hip ultrasound studies stayed normal and had normal x-rays at 6 months.
Comments:
Hip clicks do not necessarily mean that the infant has hip dysplasia, but an evaluation is sometimes needed. If the ultrasound study is normal, then nothing else needs to be done and the parents can safely be reassured that follow-up is not needed. A good clinical exam that demonstrates stable hips and a normal ultrasound scan are sufficient to declare ‘no-risk’ for dysplasia in infants with innocent hip clicks and no other risk factors for dysplasia.
Reference:
Radiological outcome of innocent infant hip clicks. Kane TP, Harvey JR, Richards RH, Burby NG, Clarke NM. J Pediatr Orthop B. 2003 Jul;12(4):259-63.
