Christian P. Christensen, Joseph C. McCarthy, Murray A. Mittleman, Peter Althausen, and Jo-ann Lee
During the past half century, multiple scoring systems have been devised to evaluate arthritic hip pain and measure improvement after arthroplasty. The D'Aubigne and Postel hip score5 often is used in hip evaluation in Europe, whereas the Harris hip score8 is the most frequently used method of quantifying hip arthritis in the United States. These scores focus on evaluating hip pain and function in elderly patients with degenerative joint disease. These two hip scores are relatively simple and continue to be used in modified forms to evaluate advanced arthritis of the hip.
The emergence of hip arthroscopy has required clinicians to struggle to find a way to communicate with patients and other physicians about hip pain and function in a younger, more athletic population. Some surgeons have applied the Harris or the D'Aubigne hip scores to this younger population.15 Some clinicians measure outcome by whether or not the young patient has been able to return to sport or resume an activity following hip rehabilitation or arthroscopy.6 Others have simply asked the patient whether or not they were better after physical therapy or operative intervention.6
As the authors' experience involving young, active patients with activity-limiting hip pain increased, we decided that a new scoring system was needed to assess these patients. This score was needed to measure improvement after treatment, to facilitate communication with other physicians, and to offer patients a more accurate prognosis before surgery. The Harris hip score was not appropriate for these patients because, although many have severe pain, all of them can go up and down stairs, cut their toenails, and take public transportation, and rarely do any of them require supplemental devices for ambulation. The Short Form-36 Health Survey (SF-36) and Short Form-129 Health Survey (SF-12)11,16 are excellent measures of global wellness and function, but these tools were not specific enough to measure the condition and subsequent improvement of these patients. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)2 is an excellent scoring system that is used for measuring pain, stiffness, and physical function in patients with arthritis. Although this test is self-administered, simple, reliable, and validated, it is geared toward older patients with advanced degenerative joint disease and is too nonspecific for younger patients. The MODEMS Hip/Knee Questionnaire,1 created by the American Academy of Orthopaedic Surgeons and the American Association of Hip and Knee Surgeons, was thought to be too long and also too focused on arthritis and degenerative joint disease for the purpose of younger patients.
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