Oxford Hip Score

Introduction[edit | edit source]

Total hip replacement

The Oxford Hip Score (OHS) is a joint-specific, patient-reported outcome measure designed to assess disability in patients undergoing total hip replacement (THR)[1]. It was developed in 1996 to be simple to administer in order to facilitate use[2], with new scoring introduced in 2007[3].

Objective[edit | edit source]

Its' primary goal during development was to assess pain and function in patients undergoing joint replacement surgery. In addition, the OHS can be used to assess patients suitability and response to alternative, non-surgical interventions[4]. These include physiotherapy, joint supplements, and anti-inflammatory medications.

The OHS is used for studies, trials and national registers[5].

Method of Use[edit | edit source]

The OHS is a short 12-item survey that can be done with pen and paper, or online.

Patients are asked to reflect on their pain and functional ability over the previous four weeks. There are two domains (pain and function) with six items or questions in each. Each item has five possible responses. In the original scoring responses were from 1 = least difficult to 5= most difficult[2]. Item scores are summed to give a total score from anywhere between 12 and 60. The lower the score, the better the outcome.

In a 2007 update, due to confusion and variability in the clinical setting, the original authors recommended using the following scoring: responses range from 0 to 4 where 0 represents the worst outcome and 4 represents the best. In this use, 48 is the maximum (and best) score achievable[3]. A guide to the new scoring can be found here. A minimum clinically important difference of 3-5 points has been suggested, but not verified[3].

It should be clearly documented which scoring system is used[3].

Score Interpretation[edit | edit source]

The scores for the 0-48 scale can be interpreted as follows[6]:

Score 0 to 19 May indicate severe hip arthritis. It is highly likely that you may well require some form of surgical intervention, contact your family physician for a consult with an orthopaedic surgeon.

Score 20 to 29 May indicate moderate to severe hip arthritis. See your family physician for an assessment and x-ray. Consider a consult with an orthopaedic surgeon.

Score 30 to 39 May indicate mild to moderate hip arthritis. Consider seeing your family physician for an assessment and possible x-ray. You may benefit from non-surgical treatment, such as exercise, weight loss, and/ or anti-inflammatory medication.

Score 40 to 48 May indicate satisfactory joint function. May not require any formal treatment.

Validity and Reliability[edit | edit source]

The OHS is generally accepted as well validated[7].

One study examining the validity of the German adaptation found it is practicable, reliable, and valid for self assessment of pain and function[8]. The OHS has also been translated to Dutch[9], Japanese[10], Indonesian[11], Farsi[12], French[13] and Spanish[14]

When compared to other outcome measures, it is strongly correlated with the Hip Disability and Osteoarthritis Outcome Score (HOOS).[15] Furthermore, it was reported that the OHS is more responsive than both generic measures, such as the Short Form 36 and EuroQol 5‐domain, and the disease‐specific measures, such as the Western Ontario and McMaster Universities Osteoarthritis Index and the Arthritis Impact Measurement Scales[5].

This review by Nilsdotter and Bremander (2011) also noted the OHS has excellent psychometric properties, although issues to look out for were double-barreled questions and a lack of questions regarding medication and aids[5]. The content validity was also questioned by Holmenlund et al (2021), citing lack of important items for present-day patients, including physical activities and quality of life [16]. However, Martín-Fernández et al (2017) supports that it is a useful, acceptable tool for the assessing perceived health related quality of life, and has psychometric properties that allow for discriminating both a patient's condition at a given moment and changes that can occur over time[14]. Supporting this, Kang (2021) found the OHS to have high univariate and multivariate responsiveness[17].

The OHS has high internal consistency up to one year after surgery [18][19].

Resources[edit | edit source]

Online Oxford Hip Score

References[edit | edit source]

  1. Wylde V, Learmonth ID, Cavendish VJ. The Oxford hip score: the patient’s perspective. Health and quality of life outcomes. 2005 Dec;3(1):66.
  2. 2.0 2.1 Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br 1996; 78: 185–90.
  3. 3.0 3.1 3.2 3.3 Murray DW, Fitzpatrick R, Rogers K,Pandit H, Beard DJ, Carr AJ, et al. The use of the Oxford Hip and Knee Scores. J Bone Joint Surg Br 2007; 89: 1010–4.
  4. Neufeld ME, Masri BA. Can the Oxford Knee and Hip Score identify patients who do not require total knee or hip arthroplasty? Bone Joint J. 2019 Jun;101-B(6_Supple_B):23-30.
  5. 5.0 5.1 5.2 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 Res. 2011. 63; S11 Supplement: Special Outcomes: S200-S207.
  6. MEDICI Medical Practice, 2019. Accessed 24 June 2019. Available from: http://www.medicipractice.co.uk/navigator/oxford-hip-score/
  7. Polascik BA, Hidaka C, Thompson MC, Tong-Ngork S, Wagner JL, Plummer O, Lyman S. Crosswalks Between Knee and Hip Arthroplasty Short Forms: HOOS/KOOS JR and Oxford. J Bone Joint Surg Am. 2020 Jun 3;102(11):983-990
  8. Florian D, Marc S, Franco M, Fabian VK, Anne F, Micheal L. Reliability and Validity of the cross-culturally Adapted German Oxford Hip Score. Clin Orthop Relat Res. 2009;467(4):952-957.
  9. Gosens T, Hoefnagels NH, de Vet RC,Dhert WJ, van Langelaan EJ, Bulstra SK, et al.The “Oxford Heup Score”: the translation and validation of a questionnaire into Dutch to evaluate the results of total hip arthroplasty. Acta Orthop 2005; 76: 204–11.
  10. Uesugi Y, Makimoto K, Fujita K, Nishii T,Sakai T, Sugano N. Validity and responsiveness of the Oxford Hip Score in a prospective study with Japanese total hip arthroplasty patients. J Orthop Sci 2009; 14:35–9.
  11. Silitonga J, Djaja YP, Dilogo IH, Pontoh LAP. Cross-cultural adaptation and psychometric validation of the Indonesian version of the Oxford Hip Score. Bone Jt Open. 2021 Sep;2(9):765-772.
  12. Nourbakhsh M, Zarezadeh A, Shemshaki H, Etemadifar MR, Moezi M, Mazoochian F. Translation and cultural adaptation of the oxford hip score for Iranian population. Int J Prev Med. 2013 Feb;4(2):141-5
  13. Delaunay C, Epinette JA, Dawson J,Murray D, Jolles BM. Cross‐cultural adaptations of the Oxford‐12 Hip score to the French speaking population. Orthop Traumatol Surg Res 2009; 95: 89–99.
  14. 14.0 14.1 Martín-Fernández J, Gray-Laymón P, Molina-Siguero A, Martínez-Martín J, García-Maroto R, García-Sánchez I, García-Pérez L, et al. Cross-cultural adaptation and validation of the Spanish version of the Oxford Hip Score in patients with hip osteoarthritis. BMC Musculoskelet Disord. 2017 May 22;18(1):205
  15. Putman S, Preda C, Girard J, Duhamel A, Migaud H. Mapping and Crosswalk of the Oxford Hip Score and Different Versions of the Hip Disability and Osteoarthritis Outcome Score. Clin Orthop Relat Res. 2021 Jul 1;479(7):1534-1544
  16. Holmenlund C, Overgaard S, Bilberg R, Varnum C. Evaluation of the Oxford Hip Score: Does it still have content validity? Interviews of total hip arthroplasty patients. Health Qual Life Outcomes. 2021 Oct 9;19(1):237.
  17. Kang S. Assessing responsiveness of the EQ-5D-3L, the Oxford Hip Score, and the Oxford Knee Score in the NHS patient-reported outcome measures. J Orthop Surg Res. 2021 Jan 7;16(1):18. doi: 10.1186/s13018-020-02126-2. Erratum in: J Orthop Surg Res. 2021 Feb 5;16(1):115.
  18. Weel H, Lindeboom R, Kuipers SE, Vervest TMJS. Comparison between the Harris- and Oxford Hip Score to evaluate outcomes one-year after total hip arthroplasty. Acta Orthop Belg. 2017 Mar;83(1):98-109.
  19. Yeoman TFM, Clement ND, Macdonald D, Moran M. Recall of preoperative Oxford Hip and Knee Scores one year after arthroplasty is an alternative and reliable technique when used for a cohort of patients. Bone Joint Res. 2018 Jun 5;7(5):351-356.