Harris Hip Score

Harris hip score explained

This hip scoring method was developed by Harris in 1969 as a mean of evaluating patient outcome after total hip arthroplasty.

In time, clinical scope of the score has increased and now it is used for hip replacement, assessment of femoral neck fractures and hip osteoarthritis.

The table below lists the items in the hip score and their accompanying answer choices.

The pain item measures pain severity and usage of pain medication. The Limp, Support, Distance walked items evaluate whether gait symptoms are present.

The degree of impairment in daily activities is assessed through items:

■ Sitting;

■ Public transportation;

■ Stairs;

■ Putting on shoes and socks.

For the range of motion scale, the normal values are:

■ Flexion: 140 degrees;

■ Abduction: 40 degrees;

■ Adduction: 40 degrees;

■ External rotation: 40 degrees;

■ Internal rotation: 40 degrees.

Compared to the test of walking speed, pain and the function subscales in the SF-36 for patients diagnosed with osteoarthritis of the hip, the Harris hip score is deemed more responsive.

There are other similar assessment scores that focus on articulation mobility and dysfunction in performing daily activities, like the Knee injury and osteoarthritis outcome score (KOOS).

Score interpretation

The ten items in the Harris hip score consist of answer choices, awarded a number of points. There are four domains evaluated, as follows:

■ Pain – 1 item which scores between 0 and 44;

■ Function – 7 items, scores are between 0 and 47;

■ Deformity – 1 item which scores either 0 or 4;

■ Range of motion – 1 item which scores between 0 and 5.

The overall score varies between 0 and 100, where scores closer to 0 are suggestive of impaired hip function and scores closer to 100 indicate positive outcome.

There are four categories of hip function status:

■ <70: poor hip status;

■ 70 – 79: fair hip status;

■ 80 – 89: good hip status;

■ 90 – 100: excellent hip status.

For post hip surgery patients, any increase of more than 20 points in the score, when correlated with radiographic evidence of the implant stability, means that there is no need to consider additional femoral reconstruction.

Benefits

Clinically, the score has shown consistency, inter and intra observer reliability in the outcome assessment of hip replacement surgery patients. It is fast to administer (takes around 5 minutes to complete) and is easy to score.

Given that it is assessor reported, it avoids part of the subjectivism, incompleteness or delayed response rate of patient-reported tools.

It can also be used in monitoring progress during physical therapy.

Limitations

After its creation, the Harris hip score has been subject to different studies and some have found that the score is susceptible to ceiling effects.

This means that in some cases, the highest scores are not able to properly assess a patient’s level of ability.

As a clinician-based tool, the score is subject to observer bias or marginalization of a patient’s perception of symptoms.

Some critics also mention the fact that the score has yet to be properly validated.

Original source

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(4):737-55.

Other references

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 & research. 2011; 63(S11), S200-S207.

2. Söderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop Relat Res. 2001; (384):189-97.