Harris Hip Score

Original Editor - Ajay Upadhyay

Top Contributors - Lauren Lopez, Ajay Upadhyay and Kim Jackson  

Objective

The Harris Hip Scale (HHS) was developed for the assessment of the results of hip surgery, and is intended to evaluate various hip disabilities and methods of treatment in an adult population. The original version was published 1969[1]. The HHS is an outcome measure administered by a qualified health care professional, such as a physician or a physical therapist.

Intended Population

People with a total hip replacement (THR), femoral neck fractures or osteoarthritis[2].

Method of Use

No training is required to administer the HHS and it requires very little time or equipment (goniometer, plinth) to complete. There are ten items covering four domains. The domains are pain, function, absence of deformity, and range of motion[2].

The pain domain measures pain severity and its effect on activities and need for pain medication. The function domain is divided into daily activities and gait. The deformity domains observes hip flexion, adduction, internal rotation, and extremity length discrepancy while the range of motion domain asses hip ROM.

The HHS is divided into three sections. The first section are questions about pain and its impact which are answered by the patient or client. The second and third sections require the physiotherapist to assess the patient or client's hip joint and function.

The HHS is a measure of dysfunction so the higher the score, the better the outcome for the individual. Results can be recorded and calculated online. The maximum score possible is 100. Results can be interpreted with the following[1]: <70 = poor result; 70–80 = fair, 80–90 = good, and 90–100 = excellent.

Evidence

Reliability

Test-retest reliability is "excellent" for both physicians (r = 0.94) and physiotherapists (r = 0.95)[3] with an interval of three to for weeks.

One study[3] reported the inter-rater correlation as good to excellent (0.74–1.0) for the domain scores, as did a study by Kirmit et al[4].

Validity

In terms of content validity, The HHS has demonstrated no major differences when tested against the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form 36 (SF-36)[3].

When assessing for construct validity, the pain and function domains in HHS have been shown to correlate with similar domains in the WOMAC[3][5], Nottingham Health Profile[5][6], and the SF‐36[3][5], particularly the physical (but not mental) domains of the SF-36[7].

Responsiveness

Wamper et al[8] report unacceptable ceiling effects in 31 of 59 studies. Pooled data across the studies included (n = 6,667 patients) suggested ceiling effects of 20% (95% confidence interval 18–22).

In a study of 335 THRs, Shi et al[9] found the HHS was responsive to pain and function at six months post-operatively but week at the two year follow up.

References

  1. 1.0 1.1 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; 51:737–55.
  2. 2.0 2.1 Nilsdotter A, Bremander A. 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 Res. 2011. 63; S11 Supplement: Special Outcomes: S200-S207. Accessed 21 June 2019.
  3. 3.0 3.1 3.2 3.3 3.4 Söderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop Relat Res. 2001 Mar;(384):189-97. Accessed 21 June 2019.
  4. Kirmit L, Karatosun V, Unver B, Bakirhan S, Sen A, Gocen Z. The reliability of hip scoring systems for total hip arthroplasty candidates: assessment by physical therapists. Clin Rehabil. 2005 Sep;19 (6):659-61. Accessed 21 June 2019.
  5. 5.0 5.1 5.2 Soderman P, Malchau H, Herberts P.Outcome of total hip replacement: a comparison of different measurement methods. Clin Orthop Relat Res 2001; 390:163–72.
  6. Garellick G, Malchau H, Herberts P.Specific or general health outcome measures in the evaluation of total hip replacement: a comparison between the Harris Hip Score and the Nottingham Health Profile. J Bone Joint Surg Br 1998; 80: 600–6.
  7. Lieberman JR, Dorey F, Shekelle P,Schumacher L, Kilgus DJ, Thomas BJ, et al.Outcome after total hip arthroplasty: comparison of a traditional disease‐specific and a quality‐of‐life measurement of outcome. J Arthroplasty 1997; 12: 639–45.
  8. Wamper KE, Sierevelt IN, Poolman RW, Bhandari M, Haverkamp D. The Harris hip score: Do ceiling effects limit its usefulness in orthopedics? Acta Orthop. 2010 Dec;81 (6):703-7. Accessed 21 June 2019.
  9. Shi HY, Mau LW, Chang JK, Wang JW,Chiu HC. Responsiveness of the Harris Hip Score and the SF‐36: five years after total hip arthroplasty. Qual Life Res 2009; 18:1053–60. Accessed 22 June 2019.
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