Description

The Harris Hip Score (HHS) is one of the most widely recognized and extensively used clinical outcome measures for evaluating hip function. Developed by William H. Harris, the instrument was originally designed to assess the outcomes of total hip arthroplasty. Today, it is broadly applied in the evaluation of patients with hip osteoarthritis, femoral neck fractures, avascular necrosis, inflammatory joint diseases, traumatic injuries, and other musculoskeletal disorders affecting the hip.

The HHS provides a comprehensive assessment of hip health by combining measurements of pain, functional ability, range of motion, and anatomical deformity. It enables healthcare professionals to objectively evaluate disease severity, monitor patient recovery, and measure the effectiveness of both conservative and surgical interventions. Owing to its strong psychometric properties and widespread clinical acceptance, the Harris Hip Score remains a benchmark instrument in orthopedic research and clinical practice.

Questionnaire Structure

The Harris Hip Score consists of four principal assessment domains:

  • Pain: Evaluates the intensity, frequency, and impact of hip pain on daily life. This domain contributes the largest proportion of the overall score.
  • Function: Assesses the patient’s ability to perform everyday activities, including walking distance, stair climbing, sitting, putting on shoes and socks, and the need for walking aids.
  • Range of Motion: Measures hip joint mobility through a standardized clinical examination.
  • Absence of Deformity: Evaluates anatomical alignment and the presence of structural deformities that may compromise joint function.

Unlike many purely patient-reported outcome measures (PROMs), the original Harris Hip Score combines patient-reported information with clinician-based physical examination findings, making it a hybrid clinical assessment instrument.

Data Analysis and Applications

Analysis of the Harris Hip Score involves calculating a total score after all assessment domains have been completed. Data collection incorporates both patient responses and objective clinical findings recorded by trained healthcare professionals.

The HHS is widely used for:

  • Preoperative and postoperative assessment of total hip replacement patients.
  • Evaluation of hip osteoarthritis and other degenerative joint disorders.
  • Monitoring recovery following orthopedic surgery or rehabilitation programs.
  • Assessing treatment effectiveness in clinical practice.
  • Comparing outcomes across clinical trials and orthopedic research studies.

The psychometric evaluation of the HHS commonly includes measures of internal consistency (Cronbach’s alpha), test–retest reliability, inter-rater reliability, construct validity, and criterion validity through comparisons with other validated hip-specific instruments such as the WOMAC, Oxford Hip Score (OHS), and Hip Disability and Osteoarthritis Outcome Score (HOOS).

Objective

The primary objective of the Harris Hip Score is to provide a standardized, reliable, and objective evaluation of hip function and its impact on an individual’s daily activities and quality of life.

More specifically, the HHS aims to:

  • Assess the severity of hip pain.
  • Evaluate functional mobility and physical performance.
  • Measure independence in activities of daily living.
  • Monitor clinical progress over time.
  • Assess the outcomes of conservative and surgical treatments.
  • Support evidence-based clinical decision-making in orthopedic care.

Scoring

The Harris Hip Score ranges from 0 to 100 points, with higher scores indicating better hip function and overall clinical outcomes.

The scoring distribution is as follows:

  • Pain: up to 44 points
  • Function: up to 47 points
  • Absence of Deformity: up to 4 points
  • Range of Motion: up to 5 points

Total scores are commonly interpreted as follows:

  • 90–100: Excellent hip function
  • 80–89: Good hip function
  • 70–79: Fair hip function
  • Below 70: Poor hip function, indicating significant impairment and the potential need for additional therapeutic intervention.

This scoring system allows clinicians to monitor patient progress longitudinally and objectively evaluate treatment outcomes following hip surgery or rehabilitation.

Psychometric Properties

The Harris Hip Score demonstrates excellent psychometric performance across a wide range of orthopedic populations. Numerous validation studies have confirmed its high reliability, reproducibility, construct validity, and responsiveness to clinical change. The instrument has been translated, culturally adapted, and validated in many languages, making it one of the most frequently used outcome measures in international orthopedic research.

Because of its standardized methodology and extensive validation, the HHS is considered a reference instrument for assessing hip function in both routine clinical practice and scientific investigations.

References

Harris, W. H. (1969). 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. Journal of Bone and Joint Surgery, 51(4), 737–755.

Harris, W. H. (1993). The Harris Hip Score. Journal of Bone and Joint Surgery.

Klassbo, M., Larsson, E., & Mannevik, E. (2003). Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Acta Orthopaedica Scandinavica, 74(6), 795–800.

Nilsdotter, A., & Bremander, A. (2011). Measures of hip function and symptoms: Harris Hip Score, HOOS, Oxford Hip Score, and WOMAC. Arthritis Care & Research, 63(S11), S200–S207.