Harris Hip Score (HHS)
The Harris Hip Score (HHS) is a clinician-based outcome measure that is frequently used for the evaluation of patients following a Total Hip Arthroplasty (THA). The tool was originally developed in 1969 but has since undergone multiple revisions. Today, the scope of HHS has increased and many clinicians now use it for the assessment of femoral neck fractures and osteoarthritis.
The HHS is composed of four subscales: pain (44 points), function (47 points), absence of deformity (4 points) and range of motion (5 points). The pain domain measures pain severity, its effect on activities and the need for pain medication. The function domain consists of daily activities and gait, while the deformity sub-scale takes into account hip flexion, adduction, internal rotation, leg length discrepancy and range of motion measures.
The survey has ten questions and scores ranging from 0-100, with higher scores representing less dysfunction and better outcomes.
Strengths
The Harris Hip Score takes about 5-7 minutes to complete and is easy for clinicians to score. Because it is not a patient reported outcome measure, 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 has also been proven an effective tool to measure outcomes after interventions such as physical therapy.
Considerations
The Harris Hip Score has been found to 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. In addition, because HHS is a clinician-based measure 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 and when used, its susceptibility to ceiling effects should be taken into account.
Licensing and Cost
The Harris Hip Score does not require a license. To view the tool, please visit: www.orthopaedicscore.com/scorepages/harris_hip_score.html.
Sources
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 | The Harris hip score: Do ceiling effects limit its usefulness in orthopedics?
