Usefulness of the Trendelenburg test for identification of patients with hip joint osteoarthritis

Abstract

This study examined validity indices of the Trendelenburg test as a measure of hip abductor muscle performance (adduction of pelvis-on-femur [P-O-F]) when identifying subjects with and without hip joint osteoarthritis (OA). Muscle performance of the hip abductor muscles was obtained in standing by using the P-O-F position measured with a goniometer and in supine using a handheld dynamometer (HHD) and a manual muscle test (MMT). We studied 20 healthy adults (10 men and 10 women) and 20 adults (10 men and 10 women) with radiographically documented hip joint OA. Indices including sensitivity, specificity, and positive likelihood ratios examined values obtained from the P-O-F position and the MMT when used to identify subjects with and without hip joint OA. Sensitivity of the P-O-F position for identifying subjects with hip joint OA was 0.55, and specificity was 0.70, yielding a positive likelihood ratio of 1.83. Sensitivity of normalized hip abductor MMT strength for identifying subjects with hip joint OA was 0.35 and specificity was 0.90, yielding a positive likelihood ratio of 3.5. Based on validity information from the present study, the Trendelenburg test (P-O-F angle) is not useful in identifying subjects in the early stages of hip joint OA.

Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis

“…37 38 Trendelenburg's test, resisted hip abduction,37 and FABER's test38 were investigated and were considered high quality studies. Of the three tests the resisted hip abduction test yielded small post-test probability influence (LR+ 3.5), the highest of the three.…”

Steps Toward the Validation of the Trendelenburg Test

“…2,8 Although a standard method to perform the test has been described for use within clinical populations, 7 only a few studies have investigated Trendelenburg's hypotheses. [9][10][11] DiMattia et al 9 investigated the usefulness of the TT as a screening measure for HABD using biomechanical methods. Measures of isometric HABD strength and peak ipsilateral hip adduction angle (iHADD) were found to have weak and nonsignificant correlation during the TT.…”

“…Despite significant differences in HABD strength between the 2 groups, poor sensitivity, specificity, and receiver operating curve values were reported. 11 The authors suggest that the TT provides "no better information than a 50:50 chance of identifying hip osteoarthritis patients from controls." 11 Previous studies have generally shown that the use of the TT is limited.…”

“…11 The authors suggest that the TT provides "no better information than a 50:50 chance of identifying hip osteoarthritis patients from controls." 11 Previous studies have generally shown that the use of the TT is limited. These studies have sought to indirectly determine the relationships between HABD strength and measures of frontal plane motion.…”

Gait variability and symmetry assessment with inertial sensors for quantitative discrimination of Trendelenburg sign in total hip arthroplasty patients: a pilot study based on convenience sampling

“…The TT should be reserved for use with populations with marked hip abductor muscle weakness, not being recommended as a screening measure for hip abductor muscle strength in populations with strength greater than 30% of body weight (Kendall et al, 2013). In addition, the TT is not useful in identifying subjects in the early stages of hip joint osteoarthritis, whose sensitivity of pelvis-on-femur adduction measured with a goniometer was 0.55, and specificity was 0.70, and sensitivity of hip abductor manual muscle test strength was 0.35, and specificity was 0.90 (Youdas et al, 2010). When quantitative assessment is necessary, a kinematic analysis should be done in a gait laboratory to properly identify and assess gait changes related to TS.…”