The Harris Hip Score (HHS) is a clinician-based outcome tool frequently used for the evaluation of patients following a total hip arthroplasty. It was developed in 1969, and has since undergone multiple revisions. Today, the scope of the HHS has increased, and many clinicians now use it for the assessment of femoral neck fractures and osteoarthritis [1].

Four subscales make up HHS. The first is pain, which measures pain severity (44 points); function, which is made up of daily activities and gait (47 points); the absence of deformity, which is a subscale that measures hip flexion, adduction, internal rotation, leg length discrepancy and range of motion measures.(4 points), and range of motion (5 points).

 

The survey has 10 question items and scores range from 0-100 with higher scores representing less dysfunction and better outcomes.

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Strengths

The Harris Hip Score takes about 5-7 minutes to complete and is easy for clinicians to score. Because it’s not a patient-reported tool, many of the inconveniences associated with PRO instruments (ie. incomplete surveys, question ambiguity or delayed responses) don’t apply to the Harris Hip Score. It’s also been proven to be an effective tool to measure outcomes after interventions such as physical therapy [1].

 

Weaknesses

The Harris Hip Score can be susceptible to ceiling effects – a phenomenon that occurs when the highest score on a rating tool is unable to properly assess a patient’s level of ability [2]. In addition, because HHS is a clinician-based tool, it’s subject to the weaknesses that are inherent to these instruments, such as observer bias and the marginalization of a patient’s perception of their outcome.

The Harris Hip Score is useful for specific circumstances but has yet to be properly validated. When used, its susceptibility to ceiling effects should be taken into account.

 

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References

 

  1. 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
  2. Wamper, K. E., Sierevelt, I. N., Poolman, R. W., Bhandari, M., & Haverkamp, D. (2010). The Harris hip score: Do ceiling effects limit its usefulness in orthopedics?: A systematic review. Acta Orthopaedica, 81(6), 703–707. http://doi.org/10.3109/17453674.2010.537808, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216080/