Oxford Hip Score

Abstract

The Oxford Hip Score (OHS) is a widely utilized, patient-reported outcome measure specifically designed to evaluate the success and functional status following joint replacement surgery, particularly Total Hip Replacement (THR). It quantifies both the degree of pain intensity and the extent of functional limitations experienced by the patient across various daily activities.

The instrument consists of 12 items, which incorporate both disease-specific and generic questions pertaining to hip function over the preceding four weeks. The OHS provides a reliable measure for assessing post-operative recovery and long-term outcomes in orthopedic patients. The maximum achievable total score is 60, where a higher score indicates greater pain intensity and more severe functional limitation.

Keywords

Oxford Hip Score, OHS, Total Hip Replacement, Functional Limitations, Pain Intensity, Lower Extremity, Orthopedics, Patient-Reported Outcome Measure, Questionnaire.

Authors

Dawson J (1996), Gosens T (2005) (Dutch Version).

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Purpose

The primary purpose of the Oxford Hip Score is to provide a standardized, patient-centric assessment of the outcome of hip arthroplasty, focusing specifically on individuals who have undergone a Total Hip Replacement. It serves as a crucial tool for clinicians and researchers to monitor recovery trajectories, compare surgical techniques, and evaluate the overall effectiveness of interventions aimed at improving hip function and reducing pain.

The questionnaire is designed to capture the patient’s subjective experience of their hip condition, specifically addressing how pain and stiffness interfere with activities of daily living over a recent, defined period (the past four weeks). The OHS focuses on assessing changes in activities and sensory functions and pain related to the lower extremity.

Construct

The OHS measures the construct of Hip-Specific Health Status, which is operationalized through 12 items covering two primary dimensions: Pain Intensity and Functional Limitation. These items are designed to cover a range of activities that are commonly affected by hip pathology or post-surgical recovery, ensuring a comprehensive view of the patient’s quality of life related to their lower extremity.

The inclusion of both disease-specific and generic questions allows the instrument to capture the impact of the hip condition while maintaining relevance across various patient experiences following orthopedic intervention. The measurement targets conditions related to the Musculoskeletal System, particularly Bone, Joint, and Cartilage Disorders.

Validity

The original development of the OHS established strong face validity and content validity, ensuring that the questions directly relate to the symptoms and limitations experienced by hip replacement patients. Multiple subsequent studies have confirmed its construct validity, demonstrating appropriate correlations with other established measures of pain, function, and general health status, such as the SF-36 subscales.

Furthermore, the OHS exhibits excellent responsiveness, meaning it is highly sensitive to clinically significant changes in a patient’s condition following surgery. This responsiveness makes it an invaluable outcome measure for clinical trials and longitudinal follow-up studies, allowing researchers to accurately gauge treatment efficacy.

Reliability

The OHS demonstrates high internal consistency, typically reported through Cronbach’s alpha values well above the acceptable threshold of 0.70 across numerous validation studies. This high consistency indicates that the 12 items reliably measure the same underlying construct of hip health status.

Excellent test-retest reliability has also been consistently reported across various populations and language adaptations, confirming that the scale provides stable measurements over time when the patient’s clinical status remains unchanged. The standardized administration and scoring procedure contribute significantly to its overall reliability in clinical settings.

Factor Analysis

While the OHS is most frequently utilized as a single, unidimensional score reflecting overall hip function and pain, factor analysis studies often support a two-factor structure in specific clinical populations, conceptually dividing the items into factors related to Pain and Physical Function. However, for clinical ease and interpretation, the single total score remains the standard method of use.

The original psychometric analysis confirmed that all 12 items contribute effectively to the overall measurement of the patient’s hip health status, confirming its utility as a brief yet comprehensive outcome measure.

Instrument

Test Type: Questionnaire (Patient-Reported Outcome Measure – PROM)

Format: 12 self-administered items, typically scored using a 5-point Likert scale. The resulting total score ranges from 12 (best function/no pain) to 60 (worst function/maximum pain) in the standardized 0-60 calculation cited in the source documentation.

Language Available: English (Original), Dutch (Dutch version by Gosens T, 2005), and various other international translations.

Population Group: Adults, Elderly.

Age Group: Typically 18 years and older.

Population Details: Patients who have received a Total Hip Replacement or who are being evaluated for conditions affecting the lower extremity, specifically Bone, Joint, and Cartilage disorders.

Test Methodology: The patient responds to questions based on their experience over the preceding four weeks. Scoring involves summing the item scores. A higher score reflects a poorer outcome (greater pain and limitation).

The original PDF explanation form can be downloaded here: OHS Explanation Form PDF.

The original PDF measurement instrument can be downloaded here: OHS Measurement Instrument PDF.

Keywords

Orthopedic Surgery Outcomes, Hip Arthroplasty, PROM, Functional Status, Activities of Daily Living, Musculoskeletal System, Post-operative Assessment.

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Authors

Author ORCID Identifier: N/A (Information not provided in source material)

Affiliation Email addresses: N/A (Information not provided in source material)

Correspondence Address: N/A (Information not provided in source material)

Permissions & Fee and Test Year

The original scale was published in 1996 by Dawson et al. The Dutch version was validated in 2005. The OHS is widely used in clinical and academic settings and is often available for non-commercial research and clinical use without a fee, though users must confirm specific licensing details with the original developers or relevant copyright holders, particularly for large-scale commercial applications.

The broad acceptance and ease of access contribute to its status as a standard outcome measure in international orthopedic literature.

Reference’s

Primary references supporting the scale development and validation include:

1. Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. Journal of Bone and Joint Surgery. British volume. 1996;78-B(2):185-190. (Original Scale Publication)
2. Gosens T, Dhert WJA, Luttjeboer J, Stoel W, Haverkamp D. De Nederlandse vertaling en validatie van de Oxford Hip Score. Ned Tijdschr Orthop 2005; 12: 121-125. (Dutch Version Validation)

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Items of the Oxford Hip Score

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

The source documentation provided focused on the structural details and target group of the scale but did not list the 12 specific questions (items). These items typically cover aspects such as walking pain, pain at night, dressing, shopping, and public transport use.

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