The Oxford Knee Score (OKS) is a patient-reported outcome measure (PROM) developed in 1996 to specifically evaluate total knee replacement outcomes. Since then, its scope has broadened to include use in other joint disorders and surgical treatment, not limited to arthroplasty.
The Oxford Knee (and Hip) Scores have undergone rigorous assessments of reliability, validity and responsiveness in many studies . They have been used in trials, audits and played a key role in the national joint replacement registries, including those in England, New Zealand and Sweden . The Oxford Knee Score is a popular PRO measure developed and validated specifically to assess function and pain after a Total Knee Arthroscopy (TKA).
The OKS questionnaire consists of twelve (12) questions that cover the function and pain of the knee. Each question is scored from 0 to 4 (0 being the worst outcome and 4 being the best). The overall score is the sum of all items and can range from 0 to 48, with higher scores corresponding to better outcomes. This simple scoring process is the one that the authors recommend to utilize.
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The Oxford Knee Score is a well-regarded PRO measure, proven to be valid and sensitive to clinically important changes over time, specifically in patients undergoing a total joint replacement. The survey is short, easy to administer and simple to score.
Early versions of this tool, a minor consideration of the Oxford Knee Score was the wording of a few questions in the survey. It was originally developed in England and some of the questions did not translate well to other cultures. New and current versions do translate for North American patient populations.
There are also concerns over the response “not at all.” The concern is that this wording is tricky and could mean the opposite of what the patient intended. This has a drastic impact on the score and decreases the reliability of the tool. As a result, new tools have been developed to remedy this issue.
Permission is required to use the Oxford Knee Score and can be acquired from Oxford University Innovation Ltd (formerly Isis Innovation and the technology transfer company of the University of Oxford) via the website or e-mail.
- Murray, D. W., Fitzpatrick, R., Rogers, K., Pandit, H., Beard, D. J., Carr, A. J., & Dawson, J. (2007). The use of the Oxford hip and knee scores. Bone & Joint Journal, 89-B(8), 1010-1014. Accessed May 19, 2016. http://dx.doi.org/10.1302/0301-620X.89B8.19424.
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Oxford Hip Score
The Oxford Hip and Knee Scores (OHS, OKS), developed in 1996 and 1998 respectively, are two (2) of the most popular PRO Measures for both TKA and THA patients. They have been modified and used for a variety of different purposes over the years, but the primary goal during the development of the OHS was to assess pain and function in patients undergoing Total Hip Arthroscopy (THA).
Today, the Oxford Hip Score is one of the most evaluated hip-specific measures, used all over the world and is available in a variety of different languages. Besides, it’s also been utilized in many controlled trials, cohort studies, and audits.
Apart from its utility in evaluating THA patients, the OHS is also used to assess patients after alternative non-surgical interventions. This includes physical therapy, joint supplements and anti-inflammatory medications.
The Oxford Hip Score questionnaire is a short 12-item survey. Its recall period is four (4) weeks and assesses pain, and function of the hip in relation to daily activities. This includes walking, dressing, climbing the stairs and sleeping. Each item has five (5) possible responses (least difficult to most difficult) and items are summed to give a score from 12-60. Higher scores represent better functionality.
Do you know the difference between the Oxford Hip Score, HOOS and HOS?
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The Oxford Hip Score is short, reproducible and extensively referenced in the orthopedic literature, making it a preferred tool for large-scale studies .
Additionally, it has been demonstrated to be highly sensitive to change in patients undergoing primary THA and revision surgery. The responsiveness of the OHS to change is generally greater than generic measures such as the SF-36 and disease-specific measures such as the WOMAC .
The Oxford Hip Survey has several considerations. Because it was designed as a site-specific outcome measure, patients may have some difficulty discriminating between pain and disability from the affected joint and that arising from an existing comorbidity.
Secondly, the OHS survey contains several double-barreled questions. This refers to when a single question is posed in such a way as it appears to be two (2) questions in one (1). For example, question three (3) of the survey asks patients “Have you had any trouble getting in and out of a car or using public transport because of your hip? (whichever you tend to use)” This may pose difficulty for a patient to answer because they may use both methods of transportation and have problems getting out of their car but no problems with using public transit, which leads to ambiguity on how to respond. During psychometric testing of an instrument, it’s always advisable to remove all double-barreled questions but unfortunately, they still exist in OHS.
Despite these considerations, the Oxford Hip Score is a validated and popular patient-reported outcome measure that has been used in large registry studies. It’s quick, easy to score and considered one of the ‘go-to’ instruments in the evaluation of patients following a THA.
Permission is required to use the Oxford Hip Score and can be acquired from Oxford University Innovation Ltd (formerly Isis Innovation and the technology transfer company of the University of Oxford) via the website or email.
- Wylde, V., Learmonth, I. D., & Cavendish, V. J. (2005). The Oxford hip score: the patient’s perspective. Health and quality of life outcomes, 3(1), 1. http://hqlo.biomedcentral.com/articles/10.1186/1477-7525-3-66
- Nilsdotter, A., & Bremander, A. (2011). Measures of hip function and symptoms: Harris hip score (HHS), hip disability and osteoarthritis outcome score (HOOS), Oxford hip score (OHS), Lequesne index of severity for osteoarthritis of the hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) hip and knee questionnaire. Arthritis care & research, 63(S11), S200-S207. http://onlinelibrary.wiley.com/doi/10.1002/acr.20549/pdf