Synopsis
Detect hip instability and acetabular underdevelopment at the age when treatment is least invasive, interpret screening correctly and coordinate harness, reduction and residual-dysplasia surveillance without causing iatrogenic harm.
- DDH ranges from shallow acetabulum to a dislocatable or fixed dislocated hip; early disease may be entirely painless and visually subtle.
- NIPE examines hips within 72 hours of birth and again at six to eight weeks, using Ortolani and Barlow manoeuvres plus later abduction and leg-length assessment.
- A true Ortolani clunk is the femoral head reducing over the acetabular rim; a soft click without translation is not equivalent.
Key red flags
A palpable Ortolani clunk as the femoral head reduces is pathological and requires direct specialist assessment even if later examinations appear normal.
Investigation priorities
Assess acetabular morphology, femoral-head coverage and dynamic stability before substantial ossification.
Management branches
A newborn or young infant attends routine examination or has a recognised DDH risk factor.
- Perform gentle bilateral stability, abduction, leg-length and associated-condition examination at the specified newborn and six-to-eight-week contacts.
- Arrange targeted ultrasound at the national programme interval for abnormal examination or qualifying breech or family risk.
The hip is irreducible, harness treatment fails or diagnosis occurs beyond the early harness window.
Key medicines
Paracetamol after reduction or cast applicationFor infants and children, prescribe the age- and weight-specific oral dose from the current BNF for Children and local postoperative protocol, documenting milligrams and maximum daily frequency rather than household spoon measures.
Ibuprofen for selected postoperative childrenUse an age- and weight-appropriate oral BNFC regimen for the shortest necessary period when hydration, renal function and bleeding risk are satisfactory and the operating team permits NSAID use.