The Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) and the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR) are short-form alternatives for the full-length Hip disability and Osteoarthritis Outcome Score (HOOS) and the Knee injury Osteoarthritis Outcome Score (KOOS) reporting tools. The HOOS JR/KOOS JR were created as a result of the increasing demand for outcome data as an efficient alternative to the full HOOS/KOOS and WOMAC assessment tools.
The widely used full HOOS and KOOS questionnaires which measure joint-specific pain and physical function contain 40 and 42 questions respectively. By contrast, the HOOS JR has six questions and the KOOS JR has seven.
The questions in the HOOS JR and KOOS JR are taken directly from their parent questionnaire and focus on the two categories of pain and activities of daily living instead of the five categories that the HOOS and KOOS focus on pain, symptoms, activities of daily living, sports & recreation, and hip-/knee-related quality of life.
The brevity of the short-form surveys allows for faster completion and greater patient engagement.
The main advantage of the HOOS JR and KOOS JR is their significantly shortened length. With a completion time of under 3 minutes, they are an attractive alternative to the longer HOOS/KOOS reporting tools.
The HOOS JR and KOOS JR have been validated by the HSS validation cohort and the FORCE-TJR registry. Internal consistency was found to be high for both the HOOS JR and KOOS JR and research suggested that there was a near-perfect correlation with both the pain and activities of daily living domains of the full HOOS/KOOS and the WOMAC reporting tool (Spearman’s correlations 0.80-0.94).
Another advantage of the HOOS JR and KOOS JR is that its scoring methodology is easier to apply than that of the HOOS/KOOS tool. In the short-form tools, patients rate each activity by indicating the amount of pain or disability they experience while carrying them out. Raw scores are added up (range 0-24 HOOS JR, range 0-28 KOOS JR) and converted to an interval score (0-100) using an interval table. The interval score represents a patient’s total joint disability where 0 corresponds to total joint disability and 100 perfect joint health.
The HOOS JR and KOOS JR have continued to grow in popularity due to insurance, prior authorization, and registry requirements, however, they do not have the amount of research and literature as their full-version counterparts. While the HOOS JR and KOOS JR provide a shorter alternative to the full-versions, they are not able to examine the various domains of hip and knee health that the full-versions do. We recommend keeping that in mind when considering the tool for detailed research projects, but also when using the tool to assess individual patients.
- 1: HOOS, JR and KOOS, JR Outcomes Surveys – HSS <https://www.hss.edu/hoos-jr-koos-jr-outcomes-surveys.asp>
- 2: Roos, E. M., & Lohmander, L. S. (2003). The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health and Quality of Life Outcomes, 1, 64. doi: 10.1186/1477-7525-1-64
- 3: Peer MA, Lane J. J Orthop Sports Phys Ther. 2013 Jan;43(1):20-8. doi: 10.2519/jospt.2013.4057. Epub 2012 Dec 7. Review.
- 4: Davis, A. M., Perruccio, A. V., Canizares, M., Hawker, G. A., Roos, E. M., Maillefert, J. F., & Lohmander, L. S. (2009). Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthritis and Cartilage, 17(7), 843-847.
- 5: Lyman, S., Lee, Y.Y., Franklin, P.D., Li, W., Mayman, D.J., Padgett, D.E. Validation of the HOOS, JR: A Short-form Hip Replacement Survey. Clin Orthop Relat Res. 2016 Jun;474(6):1472-82. doi: 10.1007/s11999-016-4718-2. Epub 2016 Feb 29. PMID: 26926772; PMCID: PMC4868170 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868170/#:~:text=The%20HOOS%20consists%20of%2040,(%5BQOL%5D%3B%20four%20items).>