Harris Hip Score (HHS)

Evaluation of hip disability and hip surgery results

The Harris Hip Score (HHS) is a joint-specific validated tool for evaluation of hip disability and assessment of hip surgery results.

It consists of 8 items to be answered by the patient regarding pain and functional capacity and 2 items that are to be answered by the examining clinician regarding range of motion and absence of deformity.

By requiring clinician input, the HHS differs from many other patient-reported outcome measures. The HHS is typically used for patients undergoing total hip replacement as well as patients with femoral neck fractures and hip osteoarthritis.

Indication

The intended indications for the HHS are the assessment of hip surgery outcome and of hip disability. The questionnaire has been used in patients with femoral neck fractures 1 and with hip osteoarthritis 2 and in patients undergoing total hip arthroplasty 3 4 5.

Items - Dimensions - Completion time

The patient has to select 1 of 2–6 response options per item for 8 items. The examining clinician has to measure several clinical parameters for 2 items.

Hip-related health is evaluated by the dimensions of pain and functional capacity (broken down into daily activities— stairs, public transport, sitting, and shoes and socks—and gait, considered in terms of limp, support and distance walked), as well as two clinical parameters (range of motion and absence of deformity).

Nilsdotter and Bremander report that it takes 5 minutes to complete 6.

Scoring method

Each item has a specific numerical scale that corresponds to descriptive response options. The number of points linked to each response option varies.

The range of motion item considers 6 motions, which are graded based on the arc of motion possible. Each range of motion gradation is linked to an index factor and a maximum possible value, which are used to calculate arc of motion points.

These points are added and multiplied by 0.05 to determine the total point for range of motion. The total score for the HHS is calculated by adding up the scores for the 4 domains (pain, functional capacity, range of motion and absence of deformity), yielding a single score.

The score for the HHS ranges from a maximum of 100 to a minimum of 0. 6

Score interpretation

The higher the score, the less the dysfunction:

< 70: poor

70–80: fair

80–90: good

90–100: excellent 7

The HHS has been validated in English 6 8, but there are very few cross-cultural adaptions to other languages 9. A German source document is available, but a German version has not been validated. 10

The questionnaire can be obtained from different sources without a license, for instance at www.orthopaedicscore.com. 11

A license is not required, and the measure can be obtained free of charge.
The HHS has wide international use and acceptance. It is a unique tool in that it involves both patient and clinician input.
Ceiling effects have been observed in a systematic review 12. Electronic administration is difficult to implement because evaluation of range of motion and absence of deformity needs a clinical visit. Moreover, the scoring mechanism is complicated because of the range of motion calculation.

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References

  1. Frihagen F, Grotle M, Madsen JE, Wyller TB, Mowinckel P, Nordsletten L. Outcome after femoral neck fractures: a comparison of Harris Hip Score, Eq‐5d and Barthel Index. Injury 2008; 39: 1147–56.
  2. Hoeksma HL, van den Ende CH, Ronday HK, Heering A, Breedveld FC. Comparison of the responsiveness of the Harris Hip Score with generic measures for hip function in osteoarthritis of the hip. Ann Rheum Dis 2003; 62: 935–8.
  3. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969 Jun;51(4):737-55. PMID: 5783851.
  4. Higgins, Brendan T., et al. “Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis.” The Journal of arthroplasty 30.3 (2015): 419-434.
  5. Söderman, Peter, et al. “Outcome after total hip arthroplasty: Part II. Disease-specific follow-up and the Swedish National Total Hip Arthroplasty Register.” Acta orthopaedica Scandinavica 72.2 (2001): 113-119.
  6. Nilsdotter, Anna, and Ann Bremander. “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 (2011): S200-S207.
  7. Marchetti, Piergiorgio, et al. “Long-term results with cementless Fitek (or Fitmore) cups.” The Journal of arthroplasty 20.6 (2005): 730-737.
  8. Singh, Jasvinder A., et al. “Clinically important improvement thresholds for Harris Hip Score and its ability to predict revision risk after primary total hip arthroplasty.” BMC musculoskeletal disorders 17.1 (2016): 1-8.
  9. Dettoni, Federico, et al. “Validation and cross cultural adaptation of the Italian version of the Harris Hip Score.” Hip International 25.1 (2015): 91-97.
  10. https://vdcpt.ch/wp-content/uploads/Harris-Hip-Score-Harris-Hip-Score.pdf
  11. Pulik, Łukasz, et al. “An update on joint-specific outcome measures in total hip replacement.” Reumatologia 58.2 (2020): 107.
  12. Wamper, Kim E., et al. “The Harris hip score: do ceiling effects limit its usefulness in orthopedics? A systematic review.” Acta orthopaedica 81.6 (2010): 703-707.