Klisic Test for DDH Screening: Procedure & Interpretation

Key Takeaways

The Klisic test is a clinical screening tool for developmental dysplasia of the hip (DDH) in neonates, using anatomical landmarks to assess hip displacement.

A positive result occurs when an imaginary line from the greater trochanter to the ASIS points above the umbilicus, indicating potential hip dislocation.

Risk factors including breech presentation, family history, female sex, and firstborn status must be documented to inform referral decisions.

Pabau’s structured clinical forms enable teams to record Klisic test findings, risk factors, and referral decisions in one integrated patient record.

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The Klisic test is a clinical screening examination used to detect developmental dysplasia of the hip (DDH) in newborns and infants. This simple, cost-effective tool takes just seconds to perform at the neonatal examination and can identify infants at risk before symptoms develop. Early detection enables timely referral for ultrasound imaging and treatment, preventing long-term disability.

Paediatricians, neonatologists, and family medicine clinicians rely on the test during newborn screening. They pair it with the Ortolani and Barlow maneuvers to form a complete neonatal hip assessment. This template provides a structured, easy-to-use form for documenting the procedure, interpreting results, recording DDH risk factors, and making informed referral decisions. Your team can complete every step without switching between separate paper records and digital systems.

What is the Klisic test?

The Klisic test is a clinical assessment method used in newborn screening to evaluate the position of the infant’s hip joint. Its name comes from the anatomical relationship it identifies: a line drawn from the greater trochanter to the anterior superior iliac spine (ASIS).

In a normal hip, this imaginary line passes at or below the umbilicus. However, a positive result, where the line points above the umbilicus, suggests the hip is displaced and warrants further imaging. The test is most effective in neonates (first weeks of life) and early infants, before hip contractures mask dysplasia.

Unlike X-ray or ultrasound, the test requires no equipment, radiation exposure, or referral delay. Clinicians perform it during the routine newborn or 6-week examination, as part of pediatric clinics’ standard screening protocol. The test is screening-grade (not diagnostic), meaning a positive result always requires confirmation with hip ultrasound before treatment decisions are made.

Legal and regulatory standards emphasize the importance of structured DDH screening. NICE guideline CG162 and the UK National Screening Committee recommend it as part of the newborn physical examination programme. The American Academy of Pediatrics also includes DDH screening in its recommended preventive care schedule.

How to perform the Klisic test: Step-by-step procedure

The Klisic test procedure is straightforward but requires precise anatomical landmark identification. Perform this examination with the infant calm, in a supine position on a warm examination surface. These five steps form the foundation of the clinical assessment:

1. Position the infant supine with hips and knees flexed to 90 degrees. The infant should be calm and relaxed; a crying or tense infant produces unreliable results.
2. Identify the greater trochanter by palpating the lateral hip prominence at the level where the femur meets the pelvis. Mark this point mentally (or with a pen, if documenting for training).
3. Locate the ASIS (anterior superior iliac spine) by palpating the bony projection at the top front of the pelvis, level with the groin. This landmark is firm and easily palpable in most neonates.
4. Imagine a line from the greater trochanter to the ASIS. In a normal hip, this line is horizontal or angled slightly downward toward the umbilicus. In hip displacement, the line angles upward.
5. Compare bilaterally and assess symmetry. Document whether the line on each side is at, below, or above the umbilicus, and note any asymmetry between sides.

The entire procedure takes 10-20 seconds per hip. Clinic automation that flags positive screenings can prompt automatic referral workflows, ensuring no case slips through.

How to interpret Klisic test results?

The Klisic test result is binary: the imaginary line is either at/below the umbilicus (negative) or above it (positive). A positive finding does not diagnose DDH. Instead, it signals that further evaluation is needed.

Never treat a positive result as a diagnosis. Ultrasound is the gold standard for confirming DDH in infants under 4 months, and X-ray is used in older children. Document the exact finding (“line above/below umbilicus on left/right”) so the pediatric orthopedic team has a clear clinical baseline.

DDH risk factors to document at screening

Infants with DDH risk factors should be screened more closely and followed up more frequently. These risk factors include:

• Breech presentation (especially breech at delivery)
• Family history of DDH or hip problems in a parent or sibling
• Female sex (DDH is 6-8 times more common in girls)
• Firstborn status
• Oligohydramnios (low amniotic fluid)
• Torticollis (tight neck muscles, associated with intrauterine positioning)
• Postural foot deformities

Include a risk-factor checklist in your assessment form so clinicians record these details at the first screening. That way, staff know which infants need follow-up ultrasound screening, even if the Klisic test appears normal. Integrated clinical records link screening results to risk factors, creating an audit trail for compliance and follow-up.

Related neonatal hip examination tests

The Klisic test is performed alongside two other key maneuvers in a complete neonatal hip examination. Each detects a different aspect of hip dysplasia and each adds clinical information.

Use all four tests in a systematic examination. Its advantage is that it remains useful throughout infancy. This makes it a core component of neonatal screening guidelines even after the Ortolani and Barlow maneuvers lose sensitivity.

Referral criteria and next steps after a positive Klisic test

A positive Klisic test (line above the umbilicus) triggers an immediate referral pathway. Timing and urgency depend on age and risk factors.

• Age under 4 weeks: Refer for hip ultrasound within 2 weeks. Early imaging allows assessment of hip stability and measurement of the acetabular index to inform treatment decisions.
• Age 4-12 weeks: Refer within 1-2 weeks. Ultrasound is still the primary imaging modality; X-ray sensitivity improves after 3-4 months.
• Age over 12 weeks: Refer for X-ray to assess acetabular index, Hilgenreiner line, and Perkin’s line. Orthopedic consultation recommended for treatment planning.
• Positive Ortolani or Barlow alongside Klisic: Urgent referral (within 1 week). Multiple positive findings have higher specificity for DDH and warrant accelerated imaging.
• Negative result but high risk factors: Ultrasound screening at 6-8 weeks is prudent, particularly for breech presentation or strong family history.

Treatment for confirmed DDH typically begins with conservative management using the Pavlik harness. This soft brace holds the hip in flexion and abduction while allowing normal movement. The Pavlik harness is most effective when started before 6 months of age. Delayed diagnosis increases the need for surgical intervention.

Documentation tip: Record the exact finding, all risk factors, other hip examination maneuvers (Ortolani/Barlow/Galeazzi), and the referral decision in one place. This creates a clear clinical trail and prevents screening gaps at follow-up visits.

Streamline your neonatal screening workflow

Pabau's structured clinical forms integrate the Klisic test assessment, risk factor documentation, and referral decision-making into your patient record. That way, teams stay aligned and no screening result gets missed.

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Who is the Klisic test helpful for?

The Klisic test is essential for any clinician performing newborn or infant examination in a pediatric, neonatal, or family medicine setting. This includes:

• Neonatologists performing day-1 and day-5 newborn examinations in hospital settings.
• Paediatricians
• Family medicine practitioners
• Nurse practitioners and physician assistants
• Midwives

Early and accurate screening improves outcomes dramatically. Infants detected early can begin conservative treatment with the Pavlik harness, reducing the need for surgery and resulting in normal hip development. Late diagnosis (after 6 months) often requires surgical intervention.

Benefits of using the Klisic test template in practice

Standardized documentation: A structured Klisic test form ensures every clinician follows the same procedure and documents findings consistently, improving audit compliance and follow-up reliability.

Risk factor integration: Recording DDH risk factors at the same visit as the screening test means high-risk infants are automatically flagged for follow-up ultrasound. This still applies even if it appears normal.

Referral clarity: A clear decision pathway (positive Klisic → ultrasound referral within X weeks) reduces delays and ensures no positive screening is missed.

Legal protection: Detailed documentation of the examination, risk factors, findings, and referral decision creates an evidence trail. This trail demonstrates compliance with DDH screening standards and protects against claims of missed diagnosis.

Team alignment: Record assessment findings in a shared clinical record. Then midwives, health visitors, paediatricians, and orthopedic specialists all see the same baseline data and can coordinate follow-up care.

Clinical audit and regulatory compliance

DDH screening is part of the UK Newborn Physical Examination Screening Programme. The NHS also recommends systematic examination of all newborns before discharge and again at the 6-8 week health visitor check. NICE guideline CG162 emphasizes the importance of documented, timely screening and clear referral pathways.

Using a standardized Klisic test form supports audit compliance. It creates a data trail showing which infants staff screened, when, and whether staff made referrals. This supports CQC inspections and demonstrates that your clinic meets the standard of care for newborn screening.

Conclusion

The Klisic test is a rapid, non-invasive screening tool that detects developmental dysplasia of the hip before symptoms develop. Early detection enables timely referral for ultrasound and conservative treatment, preventing long-term disability in thousands of infants each year.

Using a structured, documented assessment form ensures your team performs the test consistently, records risk factors, and follows clear referral pathways. This supports clinical audit compliance and demonstrates adherence to DDH screening standards. See how Pabau’s integrated clinical records help your team coordinate newborn screening and follow-up care seamlessly.

Continue your research

Need a framework for complete neonatal assessment? Safer clinical notes covers best practices for documenting all components of the newborn examination, including hip screening and follow-up decisions.

Looking for a digital intake system for paediatric clinics? Digital forms enables you to embed the Klisic test template, risk factor checklist, and referral decision tree into your patient intake workflow.

Want to track DDH screening compliance across multiple clinics? Insights Plus analytics helps you audit screening rates, referral times, and follow-up completion across your practice.

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