No inferiority of delayed radiographic screening for ‘clicky hips’ in infants during the COVID-19 pandemic

Laura Beddard, Sophie White, Robert Richards

Queen Alexandra Hospital

Guidance from British Society for Children’s Orthopaedic Surgery (BSCOS) in April 2020 suggested that ‘clicky hips’ should not undergo routine hip ultrasound during the COVID-19 pandemic. The pathway in our unit was altered to reflect this.
We present a prospective cohort study investigating the rate of radiographic features of Developmental Dysplasia Hips (DDH) in babies with clicky hips on Newborn Infant Physical Examination (NIPE) screening.

Prospective records of babies referred with ‘clicky hips’ and no risk factors or abnormal clinical examination findings between 01/02/2020 and 31/08/2020 were kept. Babies were invited for a pelvic radiograph aged 6 months.
Hospital records and digital radiography records of babies that were not brought to radiographic screening were reviewed to identify hip abnormalities diagnosed prior to 18 months of age.

310 babies were referred; 268 attended for pelvic radiograph aged 6 months. These radiographs were all within normal limits, no further investigation or treatment was required. 3 have been seen at a nearby centre. All 3 had ultrasound screening, one was successfully treated for DDH in a Pavlik harness.
3 presented later for clinical review due to parental concern. All hips were clinically and radiographically normal.

This method of screening for DDH in babies with clicky hips is shown to be as effective as ultrasound. No babies had delayed diagnosis or treatment. One baby required treatment for DDH (0.3%), lower than the proportion found in UK studies.
This supports the continued change in practice to not routinely screen ‘clicky hips’.