Muscle, joint & pain

The Harris Hip Score Your Surgeon Records

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Your surgeon records a Harris Hip Score and reads it back as a single number. Underneath it is a 1969 scoring sheet, invented inside a study of 39 hip arthroplasties, that weights pain and function heavily and the physical examination barely at all. Here is what each block of points is worth, which parts are really your own report, and why the excellent-good-fair-poor bands you will see quoted are not in the original paper.

Last updated: July 2026

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What is the Harris Hip Score?

The Harris Hip Score is a clinician-administered 100-point scale for the hip, scored in the positive direction so that higher totals mean a better hip 1. William Harris published it in 1969. It has four domains, and the weighting is the thing to notice: pain is worth 44 points, functional capacity 47, range of motion 5, and absence of deformity 4 1.

Add the first two and you get 91. Add the last two and you get 9. That ratio is the whole personality of the instrument. It is a measure of what a hip does to a life, with a small examination attached — a hip that walks well and does not hurt will score high almost regardless of what the examination finds.

Pain and function carry 91 of the Harris Hip Score's 100 points. The physical examination carries 9.

Which parts come from you, and which from the examination?

The instrument is clinician-administered — the form is filled in by the person seeing you, not handed to you in a waiting room 1. But administered is not the same as observed. Range of motion and absence of deformity are examination findings, and together they are worth 9 points 1. Pain is worth 44 points 1, and pain is not measurable by anyone but you. It reaches the form as your report, written in someone else's hand.

Functional capacity, the largest block at 47 points 1, sits in between. It describes what the hip lets you do across an ordinary day — and an examiner sees you for twenty minutes, not a Tuesday. Much of that block can only come from your account of it.

The consequence is worth sitting with. The number your surgeon quotes back to you is, for the most part, a transcription of your own testimony, weighted and totalled. That is not a criticism of the score; it is a reason to answer the questions carefully. If you describe a good week when you have mostly been having bad ones, the total moves — and the total is what gets compared against your last visit.

Where the Harris Hip Score came from

From a report on surgical results, not from a study designed to build a questionnaire. Harris introduced the score as the "new method of result evaluation" named in his paper's subtitle, embedded in an end-result study of 39 mold arthroplasties performed at Massachusetts General Hospital between 1945 and 1965, in patients with arthritis following an acetabular fracture or a hip dislocation 1.

That origin explains the shape. The score was built to answer a surgeon's question — did this operation work? — about a particular population of damaged hips. It is a derivation-in-context paper rather than a validation study: the score arrives inside a report of results, not inside a study designed to test the score, and reliability, validity, and responsiveness in the modern sense are not established there 1.

The instinct was not unique to the hip. Eighteen years later, Constant and Murley published the constant-murley score for the shoulder: likewise out of 100, likewise blending patient-reported pain and daily activity with examiner-measured motion and strength, likewise higher-is-better 2. Two joints, two decades apart, one idea — the surgeon's eye and the patient's account, averaged into a single figure. The design is common enough among hip and shoulder outcome measures that it is easy to forget how strange that averaging is.

What does a Harris Hip Score of 82 actually mean?

On its own, less than the number implies. The excellent, good, fair, and poor bands quoted alongside Harris Hip Scores are routinely attributed to Harris's paper, but that paper does not establish them as a formal cutoff scheme 1. Nor does it report a minimal clinically important difference or a minimal detectable change — it sets no threshold for how many points count as real 1.

The Harris Hip Score's familiar excellent/good/fair/poor bands are widely attributed to the 1969 paper, which does not establish them as a formal cutoff scheme 1.

So an 82 is a position on a scale whose grading came from somewhere other than the instrument's own publication. That does not make the bands worthless — clinicians use them, and a shared shorthand has real value — but it does make their source a fair question, and it makes any single total weaker evidence than it looks.

There is a second problem, built into the arithmetic. Because pain and function together carry 91 points 1, two hips can arrive at the same total by opposite routes, and those routes call for different care. A hip that hurts badly but still gets you around, and a hip that is comfortable but has stopped getting you out of the house, are not the same clinical situation. The total flattens them. The four domain scores do not.

How it differs from the hip questionnaires you fill in yourself

Those forms need no clinician at all. The Oxford Hip Score is a 12-item questionnaire the patient completes, covering hip pain and function in a single composite, developed and validated prospectively in 220 patients assessed before surgery and again at six months 3. The HOOS questionnaire is a patient-reported measure with five subscales: pain, symptoms, activities of daily living, sport and recreation, and hip-related quality of life 4.

The Oxford group earned their form's standing the same way the shoulder version later would — by agreeing with the clinician. The Oxford Hip Score's construct validity was established partly through significant correlations with the surgeon-assessed Charnley hip score 3. Patient-completed measures were validated against clinician-administered ones, which is worth remembering whenever the two are set in opposition.

Where they really differ is in what they refuse to average. The Harris Hip Score hands you one number. HOOS keeps five subscales apart 4, so a hip that is comfortable at rest but has ended your sport shows up as a low sport-and-recreation subscale instead of vanishing into a total. The WOMAC osteoarthritis index takes a middle path: three subscales — pain, stiffness, and physical function — built as a disease-specific, self-administered instrument for osteoarthritis of the hip or knee and intended as an evaluative measure for clinical trials 5.

Responsiveness is the practical difference. HOOS was found more responsive than WOMAC on its pain and symptom subscales in total hip replacement 4, meaning it registered change the older instrument partly missed. A measure that does not move when the patient does is not much use for tracking anything.

The hip the score is measuring

Most of the hips these scores get recorded on are arthritic ones. Hip osteoarthritis causes progressive pain, often felt in the groin, along with stiffness, and its initial management is nonsurgical: activity modification, exercise, and anti-inflammatory medication 6. That is the arc the number is tracking — and it gets used in two quite different ways depending on where along the arc you are.

In progressive disease the score is a slope. Recorded over years, a drifting total describes a joint that is changing, and the question it helps answer is when, not whether. Around an operation the score is a step: a figure before and a figure after, measuring an event.

Those are different instruments in practice, even though the form is identical. A total falling three points a year and a total rising thirty points in six months are answering different questions, and neither is interpretable without knowing which one you are looking at.

If what you are actually trying to do is make sense of hip pain rather than of a number, the score is the wrong place to begin. It is a way of recording what a hip is doing. It is not a way of finding out why.

What to ask about your Harris Hip Score

Ask for the four numbers, not the one. The score is built from pain, functional capacity, range of motion, and absence of deformity, weighted 44, 47, 5, and 4 1, so the total already contains a breakdown — and the breakdown is where the information lives. A drop of six points means one thing if it came out of pain and something else entirely if it came out of motion.

  • The domain scores. Worth asking which of the four blocks moved since last time, rather than only what the total did 1.
  • Where the band came from. If your number gets called good or fair, the cutoff behind that word is not from the paper that created the score 1. Its source is a reasonable question.
  • Who filled it in, and from what. The form is clinician-administered 1, but most of what fills it is your account. If something was answered on a good day about a bad month, that is worth correcting.
  • What it is being compared with. A single total is a position. Your own previous total is the one comparison that needs no cutoff at all.

The number is not the point. The hip is.

Common questions

Not usually. It is clinician-administered, which means the person seeing you completes the form. But most of what goes into it comes from you: pain and functional capacity together account for 91 of the 100 points, and pain in particular is not something anyone else can measure. The examination contributes range of motion and absence of deformity, worth 9 points between them.

The familiar answer is a band — excellent, good, fair, poor — but those bands are not established as a formal scheme by the 1969 paper that created the score, even though they are usually attributed to it. That paper also publishes no threshold for how many points count as a real change. The more answerable comparison is your own previous score.

Yes. The score runs to 100 points and is scored in the positive direction, so a higher total means a better hip. It is worth confirming the direction whenever you meet a joint score, because different questionnaires do not agree on which way they run — some count upward toward better function, others upward toward greater disability.

Because they are built differently. The Harris Hip Score is administered by a clinician and includes an examination of movement and deformity. HOOS and the Oxford Hip Score are completed by you alone, and HOOS reports five separate subscales rather than one total. They overlap, but they are not interchangeable, and a change in one does not convert into a change in another.

No single number decides that. The score is one record of how a hip is doing, and it carries no threshold from its original paper marking a hip as ready for surgery. Decisions about hip replacement weigh symptoms, function, imaging, other conditions, what has already been tried, and what matters to you. That is a conversation with a surgeon, not an arithmetic result.

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When a hip is not a scoring question

  • —Hip or groin pain after a fall, especially if you cannot bear weight or the leg looks shortened or turned outward
  • —A hip that becomes hot, swollen, and severely painful over hours, particularly with fever or chills
  • —New, unrelenting hip or thigh pain that wakes you at night and eases in no position, especially alongside unexplained weight loss
  • —A sudden inability to bear weight on a replaced hip, or a new clunk, shortening, or change in leg position after a twist or fall

A hip that will not bear weight after a fall, or a leg that looks shortened or rotated, is an emergency-department visit the same day; a hip fracture is time-sensitive. A hot, swollen joint with fever is the same.

Gale's library explains how clinical tools work; it does not interpret your score or tell you what to do about it. The Harris Hip Score is recorded and read by the clinician examining your hip, and what your number means for your care is a conversation with them.

References

  1. 1.Harris WH (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. J Bone Joint Surg Am. doi:10.2106/00004623-196951040-00012 ✓The Harris Hip Score's origin, 1969 authorship, and original structure: a clinician-administered 100-point scale across pain (44 points), functional capacity (47), range of motion (5), and absence of deformity (4), scored in the positive direction so higher totals mean a better hip; its derivation inside an end-result study of 39 mold arthroplasties at Massachusetts General Hospital, 1945-1965, for arthritis following acetabular fracture or hip dislocation. Also cited for what the paper does not do: it is a derivation-in-context paper rather than a validation study, it establishes no MCID or MDC, and it does not establish the widely quoted excellent/good/fair/poor bands as a formal cutoff scheme.
  2. 2.Constant CR, Murley AH (1987). A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160-4. PMID 3791738 ✓That the Constant-Murley shoulder score, published in 1987, is a composite scored out of 100 points across pain, activities of daily living, range of motion, and strength, combining subjective and objective components with higher scores indicating better function — used here as the shoulder parallel to the Harris Hip Score's clinician-administered composite design.
  3. 3.Dawson J, Fitzpatrick R, Carr A, Murray D. (1996). Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br. 1996;78(2):185-90. doi:10.1302/0301-620X.78B2.0780185 ✓That the Oxford Hip Score is a 12-item patient-completed questionnaire covering hip pain and function in a single composite, developed and validated prospectively in 220 patients assessed pre-operatively and at six-month follow-up, with construct validity established partly via significant correlations with the surgeon-assessed Charnley hip score. Not cited for the Oxford Hip Score's range, direction, or any change threshold.
  4. 4.Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM (2003). Hip disability and osteoarthritis outcome score (HOOS)—validity and responsiveness in total hip replacement. BMC Musculoskeletal Disorders. PMID 12777182 ✓That the HOOS is a validated patient-reported outcome measure with five separate subscales (pain, symptoms, activities of daily living, sport and recreation, hip-related quality of life), and that it was more responsive than WOMAC on its pain and symptom subscales in total hip replacement.
  5. 5.Bellamy N, Buchanan WW, Goldsmith CH, et al. (1988). Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. PMID 3068365 ✓That WOMAC is a disease-specific, multidimensional, self-administered health status instrument for osteoarthritis of the hip or knee, structured in three subscales (pain, stiffness, physical function) and intended as an evaluative instrument for osteoarthritis clinical trials. Not cited for item count, score range, direction, or any change threshold.
  6. 6.American Academy of Orthopaedic Surgeons (OrthoInfo) (2024). Osteoarthritis of the Hip. OrthoInfo — AAOS. link ✓That hip osteoarthritis causes progressive groin and hip pain with stiffness, and that its initial management is nonsurgical — activity modification, exercise, and anti-inflammatory medication.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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