The Oxford Hip and Knee Scores (OHS, OKS), developed in 1996 and 1998 respectively, are two 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 development of the OHS was to assess pain and function in patients undergoing Total Hip Replacement surgery (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. In addition, 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 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 possible responses (least difficult to most difficult), and items are summed to give a score from 12-60. Higher scores represent better functionality.
The Oxford Hip Score is short, reproducible and extensively referenced in 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. The responsiveness of the OHS to change has been found to be greater than generic measures such as the SF-36 and disease specific measures such as the WOMAC .
The Oxford Hip Survey has a number of weaknesses. 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 co-morbidity.
Secondly, the OHS survey contains a number of double-barreled questions. This refers to when a single question is posed in such a way as it appears to be two questions in one. For example, question three 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?” This may pose difficult for a patient to answer because they may 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 weaknesses, 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 Isis Innovation Ltd (the technology transfer company of the University of Oxford) here.
- 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