Oxford Hip Score Calculator

The Oxford Hip Score is deliberately narrow. It contains only twelve questions and every one of them is anchored to a hip-specific task or symptom over the previous four weeks: usual hip pain, night pain in bed, sudden stabbing or spasm pain, limping, the distance walked before pain becomes severe, climbing stairs, putting on socks or stockings, rising from a chair after a meal, work and housework, getting in and out of a car or onto public transport, shopping unaccompanied, and walking down stairs. Sock and stocking donning and rising from a chair are included precisely because they load hip flexion and rotation in ways that knee-based questionnaires do not. Each item scores 0 for the worst option and 4 for the best, and the twelve are added to give 0 to 48, with higher meaning better. Commonly used interpretive bands read a total of 0 to 19 as severe hip arthritis, 20 to 29 as moderate to severe, 30 to 39 as mild to moderate and 40 to 48 as satisfactory joint function. In practice the score is most useful as a change measure: patients presenting for hip replacement in England typically record totals in the high teens or low twenties, and mean gains after surgery are on the order of twenty points, with a minimally important change of roughly five points. The main caveats are a strong ceiling effect after successful arthroplasty, where large numbers of patients score 46 to 48 and further improvement cannot be detected, and ambiguity in bilateral disease, since patients are asked about one hip but tend to answer about their walking as a whole.

The score was created at the University of Oxford by Jill Dawson, Ray Fitzpatrick, Andrew Carr and David Murray, and published in the Journal of Bone and Joint Surgery, British volume, in 1996 under the title of a questionnaire on the perceptions of patients about total hip replacement. The design method was unusual for its time: rather than have surgeons decide what mattered, the team interviewed patients awaiting hip replacement, extracted the complaints they actually raised, and reduced that material to twelve items which were then tested in a larger surgical cohort. The intent was to capture the patient view of pain and function, in contrast with clinician-administered instruments of the era that awarded points for measured range of motion and radiographic appearance. The original publication scored each item 1 to 5 and summed to a scale of 12 to 60 in which lower numbers were better, a convention that caused persistent confusion when scores were compared between papers. In 2007 Murray and colleagues published a revision recommending the now-standard 0 to 4 item scoring and 0 to 48 total with higher as better, and this is the version in general use. Adoption widened sharply in April 2009 when the National Health Service in England began collecting the Oxford Hip Score before and after every publicly funded hip replacement as part of its Patient Reported Outcome Measures programme, making it one of the most heavily collected orthopaedic outcome measures in the world. The instrument is licensed through Oxford University Innovation.