How are the hips examined in the newborn (for developmental dysplasia)?

The hips are examined for developmental dysplasia of the hip (DDH) using the Barlow and Ortolani manoeuvres:

• Barlow - adduct the flexed hip with gentle posterior pressure to try to dislocate a dislocatable hip
• Ortolani - abduct the flexed hip with gentle lift to relocate a dislocated hip (a 'clunk')

Risk factors (breech, family history) or abnormal findings prompt hip ultrasound.

Clinical relevance. Examining the hips (Barlow/Ortolani) screens for DDH so early treatment can prevent long-term hip damage.

More Detail

Newborn hip examination for DDH

Examining the hips screens for developmental dysplasia of the hip (DDH).

The manoeuvres

• Barlow test - with the hip flexed and adducted, apply gentle posterior pressure to detect a dislocatable (unstable) hip (it dislocates).
• Ortolani test - with the hip flexed, abduct and gently lift to relocate a dislocated hip - felt as a 'clunk'.

Other signs

• Asymmetrical skin/thigh creases, limited hip abduction, and apparent leg length discrepancy (Galeazzi sign).

Risk factors and investigation

• Breech presentation, female sex, family history of DDH, and oligohydramnios increase risk.
• Hip ultrasound is performed if there are abnormal findings or risk factors (ultrasound images the cartilaginous neonatal hip; X-ray is unhelpful early).

Why it matters

• Early detection and treatment (e.g. a Pavlik harness) prevent long-term hip problems (pain, abnormal gait, early osteoarthritis).