title: Does trochanteric transfer eliminate the Trendelenburg sign in adults?
abstract: BACKGROUND
  Premature closure of the proximal femoral growth plate results in coxa brevis, which usually is associated with insufficiency of the hip abductors. Distal and lateral transfer of the greater trochanter sometimes is recommended to correct this problem. Most of what is known arises from studies of children and adolescents.
  
  
  OBJECTIVE
  We asked whether this procedure in adults with coxa brevis would eliminate hip abductor insufficiency and would improve their hip function based on the Harris hip score (HHS).
  
  
  METHODS
  We prospectively followed 11 patients, aged 19 to 55 years (mean, 40 years) who had distal and lateral trochanteric transfer. All patients had pain and a positive Trendelenburg test before surgery. This test was performed at the latest followup by three observers and the interobserver reliability was determined by the kappa coefficient. The HHS was obtained before surgery and at the latest followup. The minimum followup was 25 months (mean, 52 months; range, 25-77 months).
  
  
  RESULTS
  Insufficiency of the hip abductors was eliminated in seven (according to two observers) and eight (according to one observer) of the 11 patients after surgery; the kappa coefficient ranged from 0.79 to 1.0. The mean HHS improved from 64 points preoperatively to 76 points at the final followup. The two patients with preexisting severe osteoarthritis of the hip had the worst final scores and persisted with a positive Trendelenburg test at the final followup.
  
  
  CONCLUSIONS
  Distal and lateral transfer of the greater trochanter can eliminate insufficiency of the hip abductors and improve joint function in adult patients with coxa brevis and we believe should be considered for patients without severe osteoarthritis of the hip.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av Bandeirantes, 3900 Ribeirão Preto, SP 14048-900, Brazil. flavio@fmrp.usp.br
authors.forename: Flávio L
authors.initials: FL
authors.lastname: Garcia
authors.forename: Celso H F
authors.initials: CH
authors.lastname: Picado
authors.forename: Luís P
authors.initials: LP
authors.lastname: Cardinali
mesh_terms: D000328:Adult; D053587:Arthrometry, Articular; D019644:Arthroplasty, Replacement, Hip; D001848:Bone Diseases, Developmental / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D005269:Femur / Q000637:transplantation*; D005270:Femur Head; D006618:Hip Dislocation, Congenital / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability; D007870:Leg Length Inequality / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D011187:Posture; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D055815:Young Adult