hip arthroscopy outcome score.

SYMPTOMS AND FUNCTIONAL LIMITATIONS

 

The following questions ask about symptoms that you may experience in your hip and about the function of your hip with respect to daily activities. Please think about how you have felt most of the time over the past month and answer accordingly.

 

You should be able to fully bear weight on your leg when discharged from the hospital, but most patients may need to use crutches, a cane, or a walker for a few weeks until they are comfortable walking on their new knee. You will be given a prescription for pain medication and schedule a series of follow-up visits starting sometime around six weeks after surgery.

BOOK A CONSULTATION.

Committed to improving the quality of patient advice, treatment and care in the field of orthopaedics, book a one-on-one consultation with Dr Parminder J Singh today.​

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DOB:

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Patient Details

Modified harris hip score

Modified Harris Hip Score​

None / Able to ignore it
Slight, occasional, no compromise in activity
Mild, no effect on ordinary activity, pain after usual activity, use aspirin / ibuprofen / Tylenol
Moderate, tolerable, makes concessions, occasional narcotic
Marked, serious limitations
Totally disabled

This field is required.

Function: Gait

Limp

None
Slight
Moderate
Severe
Unable to walk

This field is required.

Support

None
Cane for long walks
Cane all the time
Crutch
2 canes
2 crutches
Unable to walk

This field is required.

Functional Activities

Please answer the following questions as they pertain to your Hip

Distance

unlimited
6 blocks
2-3 blocks
Indoors only
Bed and chair

This field is required.

Stairs

Can go up / down normally
Can go up / down normally with banister
Any method
Unable

This field is required.

Socks/Shoes

With ease
With difficulty
Unable

This field is required.

Sitting

Any chair, 1 hour
High chair, 1/2 hour
Unable to sit, Y2 hour, any chair

This field is required.

Public Transportation

Able to use public transportation
Unable to use public transportation (bus, plane...)

This field is required.

How much pain do you have

Walking on a flat surface?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Going up or down stairs?

 
4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

At night while in bed?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Sitting or lying?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Standing upright?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

How Much Pain Do You Have with

Catching or locking of your hip?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Your hip giving out on you?

 
4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Stiffness in your hip?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Decreased motion in your hip?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

What degree of difficuIty do you have with

Descending stairs?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Ascending stairs?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Rising from sitting?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Putting on socks/stockings?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Rising from bed?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

How much trouble does your hip cause you when you participate in

High demand sports involving sprinting or cutting (e.g. football, basketball, tennis, and exercise aerobics)?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Low demand sports (e.g. golfing and bowling)?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Heavy household duties (e.g. lifting firewood and moving furniture)?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Jogging for exercise?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Walking for exercise?

 
4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Light household duties (e.g. cooking, dusting, vacuuming, and doing laundry)?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

This field is required.

Enter your score:

This field is required.

Vision

Vision​

No problem at all
Mildly impaired
Significantly impaired

This field is required.

Symptoms and functional limitations

How difficult is it for you to walk long distances?

 
Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How difficult is it for you to get up and down off the floor/ground?

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How difficult is it for you to lie on your affected hip side?

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How much trouble do you have with grinding, catching or clicking in your hip?

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

Overall, how much pain do you have in your hip/groin?

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How much difficulty do you have at work because of reduced hip mobility?

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

Social, Emotion and Lifestyle concerns

How much trouble do you have with sexual activity because of your hip?

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How much of a distraction is your hip problem?

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How concerned are you about picking up or carrying children because of your hip?

 
Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How much of the time are you aware of the disability in your hip?

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

Hip Affected:

Left
Right

This field is required.

You can access the hip Arthroscopy Score Outcome References here.

Discharge from Hospital to home

Depending on how well you heal after the surgery, your stay in hospital can vary from between 4 to 10 days and you will need help at home for several weeks.

Based on your own individual circumstances you will be able to go directly home or a rehabilitation centre after your surgery. Any sutures that need to be trimmed or removed is usually done around 10 to 14 days following your joint replacement.

Outcome score Instructions:

  • These questions ask about the problems you may be experiencing in your hip, how these problems affect your life, and the emotions you may feel because of these problems.
  • Please answer each question with respect to the current status, function, circumstances and beliefs related to your hip.
  • Consider the last month.
  • The questions are formatted so that you can indicate the severity of the problem by marking the line below the question.
  • Please tick which most closely represents your situation.

Submit your outcome score form

First Name:

This field is required.

Thank You!

The form has been successfully sent.

Last Name:

This field is required.

DOB:

This field is required.

Patient Details

Modified Harris Hip Score

None / Able to ignore it
Slight/occasional, no compromised activity
Mild, no effect on ordinary activity
Moderate, tolerable, occasional narcotic
Marked, serious limitations
Totally disabled

This field is required.

Please answer the following questions as they pertain to your Hip

Function: Gait

Limp

None
Slight
Moderate
Severe
Unable to walk

This field is required.

Support

None
Cane for long walks
Cane all the time
Crutch
2 canes
2 crutches
Unable to walk

This field is required.

Distance

Unlimited
6 blocks
2-3 blocks
Indoors only
Bed and chair

This field is required.

Functional Activities

Stairs

Can go up / down normally
Can go up / down normally with banister
Any method
Unable

This field is required.

Socks/Shoes

With ease
With difficulty
Unable

This field is required.

Sitting

Any chair, 1 hour
High chair, 1/2 hour
Unable to sit, Y2 hour, any chair

This field is required.

Public Transportation

Able to use public transportation
Unable to use public transportation

This field is required.

How much pain do you have?

Instructions: The following 5 questions concern the amount of pain you are currently experiencing in the hip that you are having evaluated today. For each situation, please circle the response that most accurately reflects the amount of pain experienced in the past 48 hours. Please circle one answer that best describes your situation.

Walking on a flat surface?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Going up or down stairs?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

At night while in bed?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Sitting or lying:

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Standing upright?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

How much pain do you have with?

Instructions: The following 4 questions concern the symptoms that you are currently experiencing in the hip that you are having evaluated today. For each situation. Please tick the response that most accurately reflects the symptoms experienced in the past 48 hours. Please circle one answer that best describes your situation.

Catching or locking of your hip?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Your hip giving out on you?​

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Stiffness in your hip?​

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Decreased motion in your hip?​

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

What Degree Of DifficuIty Do You Have With

Instructions: The following 5 questions concern your physical function. For each of the following activities, please circle the response that most accurately reflects the difficulty that you have experienced in the past 48 hours because of your hip pain. Please tick one answer that best describes your situation.​

Descending stairs?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Ascending stairs?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Rising from sitting?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Putting on socks/stockings?​

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Rising from bed?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

How Much Trouble Does Your Hip Cause You When You Participate In

Instructions: The following 6 questions concern your ability to participate in certain types of activities. For each or the following activities, please circle the response that most accurately reflects the difficulty that you have experienced in the past month because of your hip pain. If you do not participate in a certain type of activity. please estimate how much trouble your hip would cause you if you had to perform that type of activity. Please tick one answer that best describes your situation.

High demand sports involving sprinting or cutting (e.g. football, basketball, tennis, and exercise aerobics)?​

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Low demand sports (e.g. golfing and bowling)?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Heavy household duties (e.g. lifting firewood and moving furniture)?

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Jogging for exercise?​

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Walking for exercise?​

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Light household duties (e.g. cooking, dusting, vacuuming, & doing laundry)?​

4. None
3. Mild
2. Moderate
1. Severe
0. Extreme

This field is required.

Enter your score:

This field is required.

No problem at all
Mildly impaired
Significantly impaired

This field is required.

Vision

Symptoms And Functional Limitations

How difficult is it for you to walk long distances?

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How difficult is it for you to get up and down off the floor/ground?​

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How difficult is it for you to lie on your affected hip side?​

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How much trouble do you have with grinding, catching or clicking in your hip?​

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

Overall, how much pain do you have in your hip/groin?​

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How much difficulty do you have at work because of reduced hip mobility?​

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

Social, Emotion And Lifestyle Concerns

The following questions ask about social, emotional and lifestyle concerns that you may feel with respect to your hip problem. Please think about how you have felt most of the time over the past month and answer accordingly.​

How much trouble do you have with sexual activity because of your hip?​

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How much of a distraction is your hip problem?​

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How concerned are you about picking up or carrying children because of your hip?​

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

How much of the time are you aware of the disability in your hip?​

Not difficult at all
Mildly difficult
Moderate difficult
Severely difficult
Extremely difficult

This field is required.

Hip Affected:

Left
Right

This field is required.

You can access the hip Arthroscopy Score Outcome References here.