The importance of combined clinical and sonographic examination of instability of the neonatal hip.

A clinically unstable hip in a new-born may be an early sign of congenital dysplasia. Unless followed and treated at a young age, it can progress to a degenerative hip joint disorder with considerable functional disability in adult life. For this reason, the early diagnosis of neonatal hip instability is crucial. We present our experience with 9199 neonates examined independently by clinical and ultrasonographic techniques. Instability was diagnosed in 0.8% of the hips. Only 47% of the unstable hips were diagnosed by the initial clinical examination, in the remainder the dysplasia was recognised only by sonography. Sonographic changes were also detected on re-examination in 6% of the unstable hips following the recognition of clinical instability. It is evident that combined clinical and ultrasonographic examination significantly improves the detection rate of dysplastic hips in new-borns.