This narrative review evaluates five hip outcome instruments — HHS, HOOS, OHS, LISOH, and the AAOS Hip and Knee Questionnaire — against standard psychometric criteria. It asks which instruments are valid, reliable, and responsive enough for clinical and research use in hip disease. Each instrument is graded on acceptability, reliability, validity, and ability to detect change.
Choosing the right outcome instrument changes what conclusions you can draw from your data. If you use the HHS as your primary endpoint in a study with 2-year follow-up, the ceiling effect means most patients will score near 100 and you will not detect real differences between groups.
For post-THR research or registry surveillance, the OHS is practical: it is self-administered, takes minutes, and a score below 27 at 6 months flags patients at roughly 10 times the revision risk of those scoring good or excellent.
For younger or more active patients with hip OA, use HOOS — its sport/recreation and quality-of-life subscales capture dysfunction that pain-and-ADL instruments miss entirely. The LISOH should not be used alone; if you encounter it in a study as the sole outcome measure, treat the validity of the pain-domain findings with skepticism.
This narrative review evaluates five hip outcome instruments — HHS, HOOS, OHS, LISOH, and the AAOS Hip and Knee Questionnaire — against standard psychometric criteria. It asks which instruments are valid, reliable, and responsive enough for clinical and research use in hip disease. Each instrument is graded on acceptability, reliability, validity, and ability to detect change.
Choosing the right outcome instrument changes what conclusions you can draw from your data. If you use the HHS as your primary endpoint in a study with 2-year follow-up, the ceiling effect means most patients will score near 100 and you will not detect real differences between groups.
For post-THR research or registry surveillance, the OHS is practical: it is self-administered, takes minutes, and a score below 27 at 6 months flags patients at roughly 10 times the revision risk of those scoring good or excellent.
For younger or more active patients with hip OA, use HOOS — its sport/recreation and quality-of-life subscales capture dysfunction that pain-and-ADL instruments miss entirely. The LISOH should not be used alone; if you encounter it in a study as the sole outcome measure, treat the validity of the pain-domain findings with skepticism.