Harris Hip Score

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Original Editor - Ajay Upadhyay

Top Contributors - Lauren Lopez, Ajay Upadhyay, Kim Jackson, WikiSysop, Tolulope Adeniji, Aminat Abolade and Lucinda hampton  

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. The HHS is a clinician-based 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.

Method of Use

The domains covered are pain, function, absence of deformity, and range of motion. The pain domain measures pain severity and its effect on activities and need for pain medication.

The function domain consists of daily activities (stair use, using public transportation, sitting, and managing shoes and socks) and gait (limp, support needed, and walking distance). Deformity takes into account hip flexion, adduction, internal rotation, and extremity length discrepancy. Range of motion measures hip flexion, abduction, external and internal rotation, and adduction.

There are ten items. The score has a maximum of 100 points (best possible outcome) covering pain (1 item, 0–44 points), function (7 items, 0–47 points), absence of deformity (1 item, 4 points), and range of motion (2 items, 5 points).

No formal training is necessary. Data calculating can be performed automatically during data processing using computer-based algorithms. Takes 5 minutes to complete.

Evidence

Thirty-eight (31 men) individuals who had undergone THR operations due to traumatic arthritis were the first patients who were evaluated with the HHS. The items were generated based on the opinion by experts that pain and functional capacity are the 2 basic considerations. They were the indications for surgery and hence received the heaviest weighting: 91 of 100 points. Wamper et al 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).

HHS responsiveness has been determined in a study of 335 THRs. The effect size between preoperative and 6-months postoperative was excellent for pain (2.80) and function (1.72), but weak in the 2-years followup, i.e., pain (0.15) and function (0.18). When comparing the HHS, Barthel Index, and EuroQol 5-domain (EQ-5D) in patients with femoral neck fractures 4 and 12 months after surgery, the standardized response mean was 0.75 for HHS, 0.40 for Barthel Index, and 0.46 for EQ-5D.

Reliability

Cronbach's alpha coefficient showed high internal consistency reliability except for deformity, which could not be calculated.

The test–retest interval was 3 to 4 weeks. The total score reliability was excellent for physicians (r = 0.94) and physiotherapists (r = 0.95). The physiotherapist and the orthopedic surgeon showed excellent test–retest reliability in the domains of pain (r = 0.93 and r = 0.98, respectively) and function (r = 0.95 and r = 0.93, respectively). The calculations were done with Pearson's and Spearman's correlation coefficients.

The interrater correlations were good to excellent (0.74–1.0) for the domain scores in Söderman's study, as well as in study by Kirmit et al.

Validity

The HHS content validity has been tested by directly comparing HHS, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form 36 (SF-36). No major differences between the scores were seen. The HHS construct validity was tested by comparing the pain and function domains in HHS, WOMAC, Nottingham Health Profile (NHP), and SF-36. The HHS domains pain and function correlated (Spearman's rho) better with similar domains in WOMAC, NHP, and SF-36 than with different domains. In another study, the same result was obtained when comparing HHS, WOMAC, and SF-36. Correlations (Kendall's tau) between HHS and SF-36 have been shown to be strong in the physical domains and weak in the mental domains. A strong correlation (Spearman's rho) has been found between HHS and NHP

References

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