Hip Outcome Score
Hip Outcome Score (HOS) · Also known as: HOS
The Hip Outcome Score (HOS) is a 29-item patient self-report instrument designed to measure symptoms, functional limitations, and activity restrictions in individuals with hip disorders. Originally developed and published by Philippon, Kelly, and Martin in 2006 in Arthroscopy, the HOS has become the standard outcome measure in hip arthroscopy, hip preservation surgery, and hip rehabilitation research, providing comprehensive assessment of pain, function in daily activities, and return-to-sport capability in hip-specific populations.
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When to use it
The HOS is indicated for patients with hip pathology, including labral tears, femoroacetabular impingement (FAI), hip osteoarthritis, hip flexor/adductor strains, post-hip arthroscopy rehabilitation, and post-hip arthroplasty. It is the gold-standard outcome measure in hip arthroscopy research and increasingly used in hip preservation surgery trials. The HOS is preferred over generic lower-extremity scales (LEFS) when hip-specific detail is important and over general quality-of-life measures (SF-36) when focused functional assessment is the goal. Use HOS when comprehensive hip outcome evaluation—with separate ADL and Sport/Rec subscales—is central to the clinical question. The HOS is less useful for populations with generalized lower-extremity pathology (e.g., post-total knee replacement); condition-specific scales should guide selection.
Strengths & limitations
- Hip-specific; measures pain and function in hip-critical movements (flexion, internal/external rotation, abduction) better than generic lower-extremity scales.
- Two-subscale structure (ADL vs. Sport/Rec) allows identification of specific functional domains affected; separates everyday function from athletic demands.
- Excellent reliability (ICC 0.92–0.96) and responsiveness; sensitive to improvements from hip arthroscopy and rehabilitation over 3–12 months.
- Extensively validated in hip arthroscopy cohorts; widely used in comparative surgery trials; free and increasingly integrated into electronic health records.
- Requires reading comprehension at 6th–8th grade level; less suitable for populations with cognitive impairment or non-English speakers without validated translation.
- 29-item length is longer than some competing scales; slightly higher response burden than LEFS (20 items), though still acceptable (10–15 minutes).
- Sport/Recreation subscale may be less sensitive in sedentary populations; 12 items focused on athletic activities may not be discriminative for non-athletic patients.
- Does not capture higher-level demands specific to certain sports (e.g., soccer cutting, ice-skating rotation); general sport items may miss sport-specific limitations.
Frequently asked
What is the difference between HOS and LEFS for hip patients?
HOS is hip-specific with separate ADL and Sport/Rec subscales; LEFS is generic for any lower-extremity joint. HOS measures hip-critical movements (hip flexion, abduction, rotation) more thoroughly. Use HOS for hip pathology (labral tear, FAI, hip OA); use LEFS for general lower-extremity function when the affected joint is unclear or multiple joints are involved. Best practice: use HOS + LEFS in hip patients for comprehensive lower-extremity assessment.
Why are ADL and Sport/Rec subscales scored separately?
Because hip problems affect daily activities and sports differently. A patient post-labral repair might have good ADL (can walk, perform self-care) but limited Sport/Rec (cannot yet cut or pivot in soccer). Separate subscales identify which domain requires more rehabilitation attention. Report both subscales; do not average them into one score.
What HOS scores indicate readiness to return to sport after hip arthroscopy?
Sport/Rec subscale >80 indicates good readiness for moderate-demand sport. For high-demand cutting/pivoting sports (soccer, basketball), target >85. For low-demand sports (swimming, cycling), >70 may suffice. Combine HOS Sport/Rec score with physical testing (hip strength, ROM, special tests) and gradual sport-specific training for comprehensive return-to-sport clearance.
Can HOS be used in patients with bilateral hip pathology?
HOS wording is singular ('your hip'), so administer for the symptomatic or more affected hip. If both hips are equally symptomatic, administer HOS twice (once per hip) and track separately. Do not combine or average bilateral hip scores; report each hip independently.
Sources
- Martin RL, Kelly BT, Philippon MJ. Evidence of validity for the Hip Outcome Score. Arthroscopy. 2006;22(12):1304-1311. DOI: 10.1016/j.arthro.2006.07.027 ↗
How to cite this page
ScholarGate. (2026, June 3). Hip Outcome Score (HOS). ScholarGate. https://scholargate.app/en/sports-medicine/hip-outcome-score
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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- Lower Extremity Functional ScaleSports Medicine↔ compare
- Patient-Specific Functional ScaleSports Medicine↔ compare