Hip dysplasia screening: Definition, Uses, and Clinical Overview

Hip dysplasia screening Introduction (What it is)

Hip dysplasia screening is the process of checking whether the hip joint is developing or functioning in a way that may allow the hip to be unstable or poorly covered.
It is most commonly used in newborns and infants to detect developmental dysplasia of the hip (DDH) early.
It can also be used in adolescents and adults when symptoms or imaging suggest under-coverage of the hip socket (acetabular dysplasia).
Screening typically combines a focused physical exam with imaging when indicated.

Why Hip dysplasia screening used (Purpose / benefits)

The hip is a ball-and-socket joint. In dysplasia, the socket (acetabulum) may be too shallow, angled differently, or positioned in a way that does not adequately cover the ball (femoral head). This can allow abnormal motion, increased contact stress, and joint irritation.

Hip dysplasia screening is used to:

• Detect hip instability or shallow socket anatomy early, before it leads to persistent dislocation, uneven growth, or joint damage.
• Differentiate normal variation from clinically meaningful findings, which helps clinicians decide whether observation, repeat checks, or further diagnostic evaluation is appropriate.
• Support timely referral (for example, to pediatric orthopedics or hip-preservation specialists) when a pattern suggests higher risk.
• Create a baseline for follow-up. In some cases, a hip may look borderline early and become clearly normal or clearly abnormal with time and growth.
• Reduce diagnostic delay in older patients with long-standing hip pain, where dysplasia can be missed if only muscle strain or “overuse” is considered.

Screening does not treat dysplasia by itself. Its value is in identifying who may need closer assessment and monitoring, and who likely does not.

Indications (When orthopedic clinicians use it)

Orthopedic clinicians and other trained clinicians commonly consider Hip dysplasia screening in situations such as:

• Newborn or infant routine checks during well-baby visits
• Any infant with a “hip click,” asymmetrical leg creases, apparent leg-length difference, or limited hip abduction noted on exam
• Infants with known risk factors (for example, breech positioning, family history of DDH, or tight swaddling practices), recognizing that risk factor emphasis can vary by clinician and case
• Follow-up of a previously abnormal or borderline hip exam or imaging study
• Adolescents with activity-related groin pain, hip fatigue, or a history of limited hip motion
• Adults with chronic groin or lateral hip pain where imaging suggests under-coverage, labral pathology, or early joint wear patterns
• Pre-participation or pre-procedure evaluation when hip morphology may affect treatment planning (varies by clinician and case)

Contraindications / when it’s NOT ideal

Hip dysplasia screening is generally low risk, but some screening approaches are not ideal in certain situations:

• Using imaging that is not age-appropriate
• Ultrasound is most informative in young infants; after the hip becomes more ossified, ultrasound windows can be less useful and radiographs may be preferred (choice varies by clinician and case).
• Unnecessary radiation exposure
• Pelvic radiographs involve ionizing radiation. Clinicians typically avoid non-essential radiographs, especially during pregnancy, and use alternative approaches when appropriate.
• Screening in place of an urgent evaluation
• If there is acute trauma, inability to bear weight, fever with severe joint pain, or other red-flag symptoms, clinicians usually prioritize urgent diagnostic pathways rather than routine screening (evaluation pathways vary by setting).
• Over-relying on a single test
• A single normal exam does not always exclude later-presenting dysplasia, and a single borderline imaging measurement does not always confirm clinically important dysplasia. Screening is strongest when findings are interpreted in clinical context.
• When symptoms point to a different primary problem
• Some hip pain is driven by non-dysplasia causes (tendon disorders, referred spine pain, inflammatory arthritis, stress fractures). In those cases, another diagnostic approach may be more informative.

“Not ideal” here usually means the method or timing should be adjusted—not that evaluation of the hip should be avoided.

How it works (Mechanism / physiology)

Hip dysplasia screening works by looking for hip instability and/or hip under-coverage and by identifying how those features relate to symptoms, growth, and function.

Core biomechanical principle

A healthy hip distributes load across a well-matched ball and socket. With dysplasia, the socket may provide less coverage, which can:

• Increase joint contact pressure in smaller areas
• Increase shear forces at the rim of the socket
• Place greater demand on the labrum (a ring of cartilage that helps seal and stabilize the joint)
• Contribute to soft-tissue irritation and, over time in some cases, earlier degenerative changes

Screening aims to detect these patterns early—especially in infants where the hip is still developing and alignment can change with growth.

Relevant anatomy (plain-language explanations)

• Femoral head (ball): the rounded top of the thigh bone.
• Acetabulum (socket): part of the pelvis that cups the femoral head.
• Labrum: fibrocartilage rim that deepens the socket and helps maintain a suction seal.
• Capsule and ligaments: connective tissues that stabilize the joint.
• Cartilage and growth plates: in infants and children, these structures influence how the hip forms over time.

What “onset and duration” means for screening

Hip dysplasia screening is not a treatment, so “duration” refers to how long findings remain relevant:

• Physical exam findings can change as the infant grows, muscle tone changes, and the hip matures.
• Imaging findings can evolve over weeks to months in infants and over longer timelines in adolescents and adults.
• Results are not always permanent; clinicians may repeat exams or imaging to confirm trends (frequency varies by clinician and case).

Hip dysplasia screening Procedure overview (How it’s applied)

Hip dysplasia screening is a structured clinical assessment rather than a single procedure. Workflows vary by age group and care setting, but a typical overview looks like this:

1) Evaluation / exam

• Review age, birth history, risk factors, symptoms (if any), and functional limitations.
• Perform a focused hip exam.
• In infants, clinicians may assess hip stability and range of motion using standardized maneuvers.
• In older patients, clinicians assess range of motion, gait, strength, and tests that may suggest intra-articular (inside-the-joint) pain.

2) Preparation

• No special preparation is usually required for the exam.
• If imaging is planned:
• Ultrasound typically requires positioning and a calm environment for infants.
• Radiographs require proper positioning to reduce measurement error.
• For MRI, screening for metal implants and discussing comfort needs may be relevant.

3) Intervention / testing

Common screening tools include:

• Physical exam
• Infant instability maneuvers (often described as Barlow/Ortolani maneuvers) performed by trained clinicians
• Observation of leg-length symmetry, thigh/gluteal crease symmetry, and hip abduction range
• Ultrasound (infants)
• Evaluates cartilaginous structures not visible on X-ray early in life
• May include measurement systems that describe femoral head coverage and socket shape (terminology varies)
• Radiographs (older infants/children/adolescents/adults)
• Pelvic X-rays can show acetabular coverage and hip alignment
• Clinicians may use standardized angles and lines to describe coverage (specific measurements and thresholds vary by clinician and case)

4) Immediate checks

• Clinician reviews whether the findings are clearly normal, clearly abnormal, or borderline/indeterminate.
• If imaging quality is limited (positioning, motion), repeat imaging may be considered.

5) Follow-up

• Next steps may include routine monitoring, repeat screening at a later interval, or referral for a more comprehensive diagnostic workup.
• Timing and intensity of follow-up vary by clinician and case, especially when findings are borderline.

Types / variations

Hip dysplasia screening is not one uniform test; it is an approach that changes by age, risk profile, and clinical question.

Universal vs selective screening (infants)

• Universal screening: many or all infants receive imaging regardless of exam findings. This approach is used in some health systems.
• Selective screening: imaging is targeted to infants with abnormal exams or defined risk factors. This approach is used in many settings.

Which model is used depends on local protocols, clinician preference, and resource availability.

Physical exam–based screening

• Newborn/infant screening exams focus on hip stability and motion.
• Pediatric follow-up exams may focus more on range of motion limits and gait as the child grows.
• Adolescent/adult exams may focus on reproduction of groin pain with motion and functional testing.

Imaging-based screening

• Ultrasound
• Most commonly used in early infancy
• Useful when the hip is largely cartilage and not well seen on radiographs
• Radiographs (X-rays)
• More commonly used when bone anatomy is more visible
• Often used to evaluate acetabular coverage in adolescents and adults
• MRI / CT (typically not first-line “screening”)
• More often used for problem-solving or pre-surgical planning than for initial screening
• MRI can evaluate labrum and cartilage; CT can detail bony anatomy (use varies by clinician and case)

Screening vs diagnostic evaluation

• Screening aims to identify who might have dysplasia and needs closer assessment.
• Diagnostic evaluation confirms the diagnosis, characterizes severity, and assesses related injuries (like labral tears) when clinically relevant.

Pros and cons

Pros:

• Helps identify hip instability or under-coverage before it becomes harder to manage
• Often noninvasive (exam and ultrasound) and typically brief
• Can be incorporated into routine pediatric visits
• Supports earlier referral when higher-risk patterns are present
• Provides a structured baseline for monitoring change over time
• Can clarify whether hip anatomy may be contributing to persistent groin pain in older patients

Cons:

• Findings can be borderline, leading to repeat visits or imaging
• Physical exam accuracy depends on examiner training and infant cooperation
• Imaging interpretation can vary with positioning and technique
• Radiographs involve ionizing radiation (dose management is part of clinical decision-making)
• Screening can detect mild variants that may never become clinically important (clinical significance varies by clinician and case)
• It does not explain every cause of hip pain, so additional evaluation may still be needed

Aftercare & longevity

Because Hip dysplasia screening is an evaluation process, “aftercare” mainly involves understanding results, tracking changes, and coordinating follow-up.

What commonly affects outcomes after screening includes:

• Severity and pattern of dysplasia
• Clear dislocation/instability tends to prompt closer follow-up than subtle under-coverage (management pathways vary by clinician and case).
• Age at detection
• In infants, the hip is developing rapidly, and screening may be repeated to confirm maturation trends.
• In adolescents/adults, symptoms and functional limits often guide how quickly further imaging or consultation occurs.
• Consistency of follow-up
• Repeat examinations or imaging may be used to confirm that hips are developing normally or to clarify borderline results.
• Coexisting conditions
• Generalized joint laxity, neuromuscular conditions, or prior hip injury can influence how findings are interpreted.
• Activity demands and biomechanics (older patients)
• Sports participation, workload, hip strength, and movement patterns may affect symptoms, but screening alone does not determine a full plan.
• Imaging method and measurement approach
• Different measurement systems and thresholds exist. Interpretations may differ across clinicians and institutions.

“Longevity” of screening results is context-dependent. A normal exam in infancy is reassuring, but clinicians may still re-check hips as part of routine care. In symptomatic adolescents/adults, screening findings often lead to more detailed diagnostic steps rather than standing alone.

Alternatives / comparisons

Hip dysplasia screening sits within a broader set of options for evaluating hip development and hip pain.

Observation / monitoring without immediate imaging

• Common when the physical exam is normal and risk is low, or when an initial finding is uncertain.
• Advantage: avoids unnecessary testing.
• Limitation: subtle dysplasia can be missed without imaging in some cases; the trade-off depends on local protocols and clinician judgment.

Ultrasound vs radiographs

• Ultrasound
• Strength: visualizes cartilage and early hip morphology in infants.
• Limitation: less useful once bony ossification limits the acoustic window; operator technique matters.
• Radiographs
• Strength: standardized views can quantify bony coverage and alignment later in childhood and adulthood.
• Limitation: uses ionizing radiation; positioning affects measurements.

Screening exam vs advanced imaging (MRI/CT)

• Physical exam + basic imaging is typically the first step.
• MRI is often used when clinicians need to assess labrum/cartilage or clarify pain sources.
• CT may be used to define bony anatomy in complex cases or for surgical planning.
• Advanced imaging is generally not considered routine screening and is used selectively (varies by clinician and case).

Screening vs “pain-first” workups in adults

In adults with hip pain, clinicians may compare dysplasia screening findings against other common causes:

• Femoroacetabular impingement (FAI)
• Tendinopathy around the hip (abductors, hip flexors)
• Referred pain from the lumbar spine
• Early osteoarthritis or inflammatory arthritis

A balanced evaluation often considers more than one contributing factor.

Hip dysplasia screening Common questions (FAQ)

Q: Is Hip dysplasia screening painful?
For most people, the screening exam involves gentle movement and observation. Infants may fuss due to handling rather than pain. Imaging such as ultrasound is typically noninvasive; radiographs require positioning but are usually quick.

Q: When is hip dysplasia usually screened for in babies?
Many healthcare systems include hip checks as part of routine newborn and early infancy visits. Some infants receive imaging early based on risk factors or exam findings, while others are monitored with repeat physical exams. The exact timing varies by clinician and case.

Q: If the exam is normal, does that rule out dysplasia?
A normal exam is reassuring, but it does not eliminate all possibility of later-detected dysplasia. Some cases are subtle early and become more apparent as the child grows or as symptoms develop later. Clinicians decide on follow-up based on the overall risk profile and findings.

Q: What does a “hip click” mean?
A click can be a nonspecific sound or sensation from soft tissues moving and does not always indicate instability. Clinicians interpret clicks alongside stability tests, range of motion, and (when appropriate) imaging. The significance varies by clinician and case.

Q: How much does Hip dysplasia screening cost?
Cost depends on the setting (clinic vs hospital), region, insurance coverage, and whether imaging is performed. A physical exam alone is typically less costly than ultrasound or radiographs, and advanced imaging is often more expensive. Billing practices vary widely.

Q: Are X-rays safe for hip screening?
Radiographs use ionizing radiation, so clinicians try to use them only when the expected benefit outweighs the exposure. When X-rays are indicated, facilities typically use pediatric-appropriate techniques when applicable. Safety considerations and imaging choice vary by clinician and case.

Q: How long do screening results “last”? Will imaging need to be repeated?
Screening reflects the hip at a point in time. In infants, repeat evaluation is common when an exam or ultrasound is borderline or when risk is higher, because the hip is still developing. In adolescents and adults, repeat imaging depends on symptoms, functional change, and initial findings.

Q: Can adults be screened for hip dysplasia, or is it only a pediatric condition?
Adults can be evaluated for acetabular dysplasia, especially when there is persistent groin pain, mechanical symptoms, or imaging patterns that suggest under-coverage. Adult evaluation often relies more on radiographs and symptom correlation than on infant instability maneuvers. The approach varies by clinician and case.

Q: Will Hip dysplasia screening affect driving, work, or weight-bearing?
Screening itself typically does not restrict activity, because it is an assessment rather than a treatment. If screening leads to additional tests or referrals, any temporary limitations would depend on the condition being evaluated and the clinician’s plan. Recommendations vary by clinician and case.

Q: What happens if screening suggests dysplasia?
Clinicians usually confirm findings with repeat exam, targeted imaging, or referral to a specialist. Next steps focus on clarifying severity, stability, and age-related considerations. Management options and timing depend on the individual situation and are not determined by screening alone.