Patient-reported outcome measure

Oxford Hip Score

The Oxford Hip Score is a 12-item patient-reported questionnaire about hip pain and everyday function over the past four weeks, each item scored 0 to 4 and summed to a total of 0 to 48 in which 48 represents the best possible hip — it is licensed by Oxford University Innovation, so the item wording is not reproduced here.

Licensed instrument12 items~5 min0–48, higher is better

This instrument is not reproduced here

The Oxford Hip Score is copyright the University of Oxford and is administered by Oxford University Innovation, which operates an active licensing programme. Non-commercial academic and clinical use is generally granted on registration, and commercial use — including use inside a commercial product, app or calculator — requires a paid licence. Because we cannot licence the items on a reader’s behalf, the questionnaire itself is not reproduced on this page and no calculator is offered. Obtain a licensed copy directly from the rights holder; the scoring rule below is published openly and is reproduced in full so that a licensed copy can be scored from this page.

Obtain a licence from the rights holder

What the Oxford Hip Score means

Oxford Hip Score scores run from 0 to 48, where a higher score is better. The bands below are conventional reporting categories, not diagnostic cut-offs.

Severe hip arthritis0–19
These groupings are the ones most commonly used in practice and in United Kingdom national reporting. Check the wording in the current Oxford University Innovation user manual, which is supplied with the licence, before quoting them in a publication.
Moderate to severe20–29
Mild to moderate30–39
Satisfactory joint function40–48

How the score is calculated

Stated in full so the calculation can be independently checked, and reproduced by hand if needed.

Each of the twelve items offers five ordered response options. Under the current scoring, the best option scores 4 and the worst scores 0, and the twelve item scores are summed to give a total from 0 to 48, with 48 the best possible hip. The original 1996 publication scored each item 1 to 5 for a total of 12 to 60, in which a LOWER score was better; the developers restated the scoring in 2007 as 0 to 48 with a higher score better, and that is the version in use today and the one collected in national arthroplasty and patient-reported outcome programmes. This reversal is the single most important thing to establish when reading an Oxford Hip Score from the literature or from a legacy database, because the two conventions run in opposite directions and a total of 20 means a good hip under the old scoring and a poor one under the new.

Missing data

The developers’ rule is that up to two missing items may be replaced by the mean of the items the patient did answer, and the total then computed as usual. With three or more items missing the questionnaire is not scored. The user manual supplied with the licence is the authority for this; confirm it there before applying it to study data.

Instrument profile

Developer: Jill Dawson, Ray Fitzpatrick, Andrew Carr and David Murray
Institution: University of Oxford, United Kingdom
First published: 1996
Custodian: Oxford University Innovation (formerly Isis Innovation), University of Oxford
Items: 12
Response format: Twelve items, each with five ordered response options scored 0 to 4
Score range: 0 to 48
Direction: Higher score = better
Recall period: The last four weeks
Completion time: About 5 minutes
Age range: Adults
Regions: Hip
Conditions: Hip osteoarthritis, Avascular necrosis of the hip, Developmental dysplasia of the hip, Post-traumatic hip arthritis
Procedures: Total hip arthroplasty, Hip resurfacing, Revision hip arthroplasty
Languages: English, German, Dutch, French, Italian, Spanish, Swedish, Norwegian, Danish, Finnish, Turkish, Chinese, Japanese, Korean, Brazilian Portuguese
Test–retest (ICC): High over short intervals in stable patients, consistently reported above 0.9
Internal consistency: Cronbach’s alpha consistently above 0.85 across languages
Validity: Correlates strongly with the WOMAC, the Harris Hip Score and the physical component of the SF-36. Its practical advantage is the size of the comparison dataset: it is collected routinely in the English national patient-reported outcome programme and in several national arthroplasty registries.
Responsiveness: Highly responsive to total hip arthroplasty, which is what it was designed for. Published minimal important change estimates vary with the population and the anchor used, and we have not verified a single figure well enough to quote it here — take the threshold from a study whose population matches yours.
Ceiling effect: Marked after successful arthroplasty, where patients cluster at 44 to 48.
Floor effect: Uncommon.

Normative values

Reference values from published cohorts, for comparison against the score you calculated.

Population	Age	Mean	SD
Patients listed for primary total hip arthroplasty, before surgery	—	Commonly in the high teens to low twenties	—
Six months after primary total hip arthroplasty	—	Commonly in the high thirties to low forties	—

When to use the Oxford Hip Score

Well suited to

Total hip arthroplasty outcome reporting in the United Kingdom and Europe, where it is the expected measure and national comparison data exist.
Short, entirely patient-reported follow-up by post or online.
Any setting where a hip-specific measure is preferred to a general health measure and the Harris Hip Score’s physical examination is impractical.

Limitations and poor fits

Young, active patients with femoroacetabular impingement or dysplasia, where the items were not designed for the relevant demands — the HOS, HAGOS or iHOT measures fit better.
Without a licence. The items are copyright and the rights holder actively administers them.
Comparing totals across studies or databases without first establishing which scoring direction each used, because the 1996 and 2007 conventions run opposite ways.
Detecting further improvement in patients already scoring in the mid-forties, because of the ceiling effect.

Oxford Hip Score compared with other instruments

Instruments measuring a related construct, with the practical difference between them.

Instrument	Items	Range	What it adds
Harris Hip Score	—	0–100	The Harris Hip Score is a 100-point clinician-administered hip assessment combining 44 points for pain, 47 for function, 4 for absence of deformity and 5 for range of motion, where 90 or above is graded excellent and below 70 poor.
HOOS	40	0–100	The HOOS is a 40-item patient-reported questionnaire that scores hip function as five separate subscales — Symptoms, Pain, Activities of Daily Living, Sport and Recreation, and Hip-related Quality of Life — each from 0 (extreme problems) to 100 (no problems).
HOS	26	0–100	The Hip Outcome Score is a 28-item patient-reported questionnaire for non-arthritic hip conditions that yields two independent percentage scores — an Activities of Daily Living subscale, administered as 19 questions of which 17 are scored, and a 9-item Sports subscale — each running from 0% (unable to perform the listed activities) to 100% (no difficulty at all).
Oxford Shoulder Score	12	0–48	The Oxford Shoulder Score is a 12-item patient-reported questionnaire about shoulder pain and everyday function over the past four weeks, each item scored 0 to 4 and summed to a total of 0 to 48 in which 48 represents the best possible shoulder — it is licensed by Oxford University Innovation, so the item wording is not reproduced here.
LEFS	20	0–80	The LEFS is a 20-item patient-reported questionnaire that measures difficulty with everyday lower limb activities on a single 0 to 80 scale, where 80 indicates no difficulty and a change of 9 points is the smallest difference patients reliably notice.

Copyright and permitted use

Published openly because it is the question every clinician and researcher asks before using an instrument, and almost nobody answers it.

Licensed instrumentRights holder: Oxford University Innovation, University of Oxford

Rights holder’s own page

References

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.
Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J. The use of the Oxford hip and knee scores. Journal of Bone and Joint Surgery (British Volume). 2007.

Editorial status

Not yet reviewedQueued for clinical review by Sam Tuffun, PT, DPT. Sign-off has not taken place — this is a placeholder assignment, not a completed review.