Harris Hip Score

Abstract

The Harris Hip Score (HHS) is a widely utilized, clinician-administered outcome measure designed to assess the function and pain associated with hip pathology. It is a combined instrument, incorporating both a patient questionnaire component and an objective observational list completed by the examiner. The HHS is primarily employed by orthopedic surgeons and physiotherapists to evaluate the health status and patient satisfaction in individuals suffering from conditions such as coxarthrosis or arthritis, particularly before and after interventions like Total Hip Replacement (THR). The score consists of 100 possible points derived from various domains, focusing on patient experience over the past week. A higher score reflects a superior health status, indicating minimal or no pain, reduced stiffness, and optimal functioning of the hip joint.

Keywords

Harris Hip Score, HHS, Total Hip Replacement, THR, Coxarthrosis, Hip Function, Outcome Measure, Orthopedics, Pain Assessment, Mobility, Lower Extremity.

Authors

Harris WH (1969), VU medisch centrum Amsterdam (Dutch Version Translation).

Purpose

The primary purpose of the Harris Hip Score is to provide a standardized, quantifiable assessment tool for measuring hip joint outcomes, particularly following reconstructive surgery such as Total Hip Replacement (THR) or other surgical procedures targeting hip arthritis. It serves as a critical instrument for monitoring patient progress, comparing the efficacy of different surgical techniques, and determining long-term functional success.

The score is designed for application both pre-operatively and post-operatively, allowing clinicians to track changes in pain levels, functional capabilities, and overall patient quality of life associated with the hip joint. Its structure allows healthcare professionals, including orthopedic surgeons and physical therapists, to systematically document improvement or deterioration in key areas of hip health.

Construct

The HHS measures the overall clinical and functional status of the hip, encompassing four major domains that contribute to the total 100-point score. These domains are weighted based on their clinical significance to patient well-being and function.

The four primary constructs measured by the Harris Hip Score are:

• Pain (44 points): This is the most heavily weighted component, assessing the severity and frequency of hip pain, ranging from no pain to crippling pain.
• Function (47 points): This domain evaluates the patient’s ability to perform activities of daily living (ADLs), including walking distance, limping, use of supports (canes/crutches), and ability to use public transportation, climb stairs, and put on shoes and socks.
• Absence of Deformity (4 points): This objective assessment, performed by the clinician, measures fixed adduction, internal rotation, and leg length discrepancy.
• Range of Motion (ROM) (5 points): This objective measure assesses the physical range of motion of the hip joint, including flexion, abduction, and rotation.

Validity

The Harris Hip Score demonstrates strong construct validity, as its components directly relate to the common symptoms and functional limitations experienced by patients with hip pathology. It exhibits high criterion validity when compared against other established general health measures and disease-specific instruments.

Specifically, studies have shown that the HHS correlates well with patient-reported outcome measures (PROMs) such as the Short Form-36 (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). However, recent literature suggests that while the HHS is highly effective in differentiating between good and excellent outcomes post-THR, it may suffer from a ceiling effect in highly active younger patients, leading to the development of modified or alternative scoring systems.

Reliability

The HHS generally exhibits good to excellent inter-rater and intra-rater reliability, particularly in the objective domains assessed by the clinician (Range of Motion and Deformity). The subjective components (Pain and Function) rely on patient recall but have also shown consistent results in test-retest scenarios.

While the original scale has demonstrated robust psychometric properties over decades of use, some variability in reliability has been noted, often attributed to differences in administration technique among clinicians, especially regarding the precise measurement of ROM and the interpretation of functional limitations. Training protocols are often recommended to maximize standardization and reliability across clinical settings.

Factor Analysis

Although the HHS is historically treated as a unidimensional scale yielding a single total score, factor analysis performed on the instrument suggests a strong two-factor structure corresponding to the primary domains: 1) Pain and 2) Function/Mobility. The objective components (Deformity and ROM) often load separately or weakly due to their limited point contribution.

This internal structure supports the clinical utility of analyzing the subscale scores (Pain and Function) independently, providing a more detailed understanding of patient recovery trajectories. Researchers frequently report the four main subscales separately to ensure comprehensive reporting beyond the single overall score.

Instrument

Test Type: Combined Observational and Self-Report Questionnaire

Format: 100-point scale, structured into four domains (Pain, Function, Deformity, and Range of Motion). The assessment covers the patient’s experience over the past week.

Language Available: Original English, Dutch (Nederlandse versie: VU medisch centrum Amsterdam), and numerous other validated translations worldwide.

Population Group: Clinical population suffering from hip pathology.

Age Group: Adults, Elderly.

Population Details: Patients diagnosed with conditions requiring hip intervention, primarily coxarthrosis, rheumatoid arthritis, or other bone, joint, and cartilage disorders of the lower extremity.

Test Methodology: The assessment is typically conducted by a trained clinician (physician or physical therapist). It involves an interview (for Pain and Function) and a physical examination (for Deformity and Range of Motion).

Keywords

Orthopedic Outcome, Hip Pain, Joint Stiffness, Activities of Daily Living, Musculoskeletal System, Coxarthrosis, THR Outcome, Clinical Assessment.

Authors

Author ORCID Identifier: N/A (Information not available in source content for WH Harris, 1969)

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

Test Year: 1969 (Original Publication).

Permissions and Fee: The Harris Hip Score is generally considered to be in the public domain for clinical and academic use, though commercial use may require specific licensing depending on the jurisdiction and specific modification utilized.

The original PDF explanation form (Toelichtingsformulier) can be downloaded here: HHS-form.pdf

Reference’s

The primary reference for the scale is the original publication by Harris, which introduced the standardized methodology for hip function assessment.

• 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. 1969. The Journal of Bone and Joint Surgery. American Volume. 2004;86-A(1):3-11.
• Dutch Version Development: VU Medisch Centrum Amsterdam.

Items of the Harris Hip Score

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The Harris Hip Score comprises 10 items contributing to the 100 total points across the four domains: Pain, Function, Deformity, and Range of Motion. Since the specific item text was provided only via a downloadable PDF link in the source material, the detailed list of items is not available here. However, the full measurement instrument (Meetinstrument) can be accessed and downloaded via the following link:

The original PDF measurement instrument can be downloaded here: HHS-meetinstr.pdf