[1] compared patients' and physicians' evaluations of the results of 147 total hip arthroplasties. There was a marked disparity between the patients' and the physicians' scores when the patients assigned a low score to a particular area. The patients' and physicians' evaluations were similar regarding the results of the total hip arthroplasty when the patients had little or no pain and were satisfied with the result. However, the disparity increased as the patients' ratings for pain increased and their ratings for over-all satisfaction decreased. This study highlighted a discrepancy between patients' and physicians' evaluations of the results of total hip arthroplasty. This discrepancy increased when the patient was not satisfied with the outcome. They concluded that the use of patients' self-administered questionnaires as well as traditional physician-generated assessments may provide a more complete evaluation of the results of total hip arthroplasty. 

[2]studied if Harris Hip Score can be used as a self-reported instrument in hip arthroplasty. This study comprised 50 primary total hip arthroplasties in 36 patients who had undergone the procedure at least 12 months before enrollment. Each patient completed a self-report Harris Hip Score (HHS) 30 days before a formal evaluation by an independent orthopedic surgeon that included a HHS. Comparison was made between the completed responses to the individual items on the self-report HHS and surgeon-assessed HHS. Concordance of item response and statistic were calculated. Overall the self-report and surgeon-assessed HHS showed excellent concordance. The results of this study supported the use of the HHS as a self-report instrument. 

In 2003, Hoeksma et al., compared the responsiveness of the Harris Hip Score with generic measures (SF-36), and a test of walking speed and pain during walking) in patients with osteoarthritis (OA) of the hip. The responsiveness ratio for the Harris Hip Score was high (1.70) compared with walking speed (0.45), pain during walking (0.66), and the subscales of the SF-36-"bodily pain" (0.42) and "physical functioning" (0.36). The area under the curve also was highest for the Harris Hip Score (0.92) compared with walking speed (0.71), pain during walking (0.73), and the SF-36 subscales-bodily pain and physical functioning (both 0.66). The Harris Hip Score was more responsive than the test of walking speed, pain, and subscales for function of the SF-36 in patients with OA of the hip.The authors concluded that he Harris Hip Score seemed to be a suitable instrument to evaluate change in hip function in patients with OA of the hip.

 [3]determined pre-morbid parameters as possible predictors of outcome of hip fracture with unstable intertrochanteric fracture treated operatively. Presence of co-morbidities, pre-injury level of ambulation, type of surgery, and period of delay in surgery were considered, and their effect on the post-operative outcome was evaluated using the Harris Hip Score. In patients with two or more co-morbidities, there is a significant effect on Harris Hip Score in terms of pain and deformity. Delay in surgery of more than two weeks significantly decreased the distance travelled at one year. The overall recovery is correlated to preinjury level of ambulation and delay in surgery. Patients with intertrochanteric fracture in this age group, who have less co-morbidities and with more independent ambulation, are good candidates for timely operative treatment. 

[4]compared the functional Outcome of Intertrochanteric Fractures of Femur treated with Dynamic Hip Screw verses Proximal Femoral Nail in terms of Harris Hip Score at one year. 50% patients in DHS group while 25% patients in PFN group had excellent HHS. The outcome was comparable in DHS group compared to PFN group. They concluded that in stable as well as in unstable peri trochanteric femoral fractures final result in terms of functional outcome are similar after one year and the choice of implant in these kind of fractures should be according to the surgeons experience and preference. 

[5]compared the results of proximal femoral nail (PFN) and dynamic hip screw (DHS) in treatment of intertrochanteric fractures. 63 patients were treated by a dynamic hip screw (DHS) and proximal femoral nail in Service of Trauma in Regional Hospital Durres during 2012-2014. Patients were operated under X-ray intensifier control. Functional outcome, duration of operation, blood loss were studied and statistically evaluated for both of groups. The patients treated with PFN had better Harris Hip Score in the early period (at 1^st and 3^rd month) and earlier ambulation, but in the long term (at 6^th and 12^th months) both the implants had the same functional outcomes. Findings indicated that PFN may be a better choice than DHS in the treatment of intertrochanteric fractures. 

[6]compared dynamic hip screw & proximal femoral nail in treatment of intertrochanteric fracture. This was a prospective randomized study from July 2014 to July 2016 for management of intertrochanteric fracture treated by dynamic hip screw & proximal femur nail in 60 cases. At 2 weeks mean Harris score was 49.30 in DHS group and 57.03 in PFN group. At 4 weeks mean Harris score was 57.03 in DHS group and 61.55 in PFN group. At 6 weeks mean Harris score was 68.79 in DHS group and 71.49 in PFN group. At 3 months mean Harris score was 75.73 in DHS group and 78.04 in PFN group. At 6 months mean Harris score was 79.12 in DHS group and 80.96 in PFN group. At one year mean Harris score was 81 in DHS group and 83.89 in PFN group this means PFN group had better HARRIS score than DHS group but not statistical significant at 4 wks to 1yrs. To analyzed this mean difference for significance Z test was applied and Z value was 2.10 for HARRIS score in 2 weeks which was statistically significant, DHS and PFN group. Among 15 cases with excellent outcome 7 are in DHS and 8 in PFN group. Among 17 cases with good outcome 8 are in DHS and 9 are in PFN group. Among 17 cases with Fair outcome 8 are in DHs group and 9 are in PFN group. Among 4 cases with poor outcome 3 are in DHS group and one in PFN group this means PFN group had better outcome than DHS group but not statistical significant. To test whether this difference is statistically significant or not Chi-square test was applied as test of significance. Chi square value worked out to be 0.15 which was statistically not significant (P>0.05). 

[7]evaluated the findings of cemented bipolar hemiarthroplasty as an alternative to other treatment modalities such as DHS or PFN. 21 elderly patients with comminuted and unstable intertrochanteric fractures underwent cemented bipolar hemiarthroplasty. This study included 22 cases of intertrochanteric fracture. Mean age of patients was 73.3 (range 60 - 91). All patients are treated with bipolar hemiarthoplasty. Patients are followed up for a mean period of 6 months (range 3-9 months). These patients were evaluated using the Harris hip scoring system. 21 out of 22 had excellent to fair outcomes. Conclusions: In our study of 22 patients, 21 had excellent to fair outcomes with primary cemented bipolar hemiarthroplasty. Bipolar hemiarthoplasty offers good functional outcome and early weight bearing and mobilization. 

Harris Hip Score (HHS) is a surgeon administered measurement for assessing hip function before and after total hip arthroplasties (THA). Patient reported outcome measurements (PROMs) such as the Oxford Hip Score (OHS) are increasingly used. Weel et al., in 2017, compared HHS to the OHS assessing whether the HHS can be replaced by the OHS for clinical evaluation of THAs. All patients were asked to complete an OHS before and one-year after surgery. The surgeon independently scored the HHS at the same time points. The authors examined and compared the clinimetric properties of both instruments. Internal consistency reliability of the OHS was notably higher than that of the HHS at all occasions. HHS had a higher effect size (4.1) than the OHS (2.1). Ceiling effect at follow up was 55.6% (HHS) and 36.4% (OHS). Spearman's rank correlation between HHS and OHS was 0.57 at baseline and 0.65 and after one year. The correlation between the change scores was 0.50. The Oxford Hip Score was concluded to be of good use in quality assessment after THA.[8]

[9]reviewed the long-term functional outcome of Intertrochanteric femoral fractures treated with dynamic hip screw (DHS) v/s proximal femoral nail (PFN). This study was conducted on 1000 patients of both sexes with intertrochanteric femoral fractures above 16 years of age group which were operated for intertrochanteric femoral fracture by DHS (500 patients) and PFN (500 patients) from January 2009 to December 2012. Functional results were assessed by Harris hip scoring system. Most of patients (95.0%) have good to excellent outcome in PFN group compare to (90.0%) in DHS. They concluded that long term functional outcome measured by HHS of Intertrochanteric femoral fractures treated with dynamic hip screw v/s proximal femoral nail have no significant difference. 

[10]compared outcome in terms of Harris Hip Score between DHS and PFN in intertrochanteric fractures of femur. A total of 40 patients with fracture inter-trochanteric femur were taken for evaluation of DHS vs. PFN. Mean Harris Hip Score among the patients of DHS group and the PFN group was found to be 83.75 and 84.4 respectively. No significant results were obtained while comparing the mean HHS in between the DHS group and the PFN group (Pvalue > 0.05). But at 6 months most of cases in PFN belongs to excellent and good groups but in DHS most of cases belongs to good and fair group of Harris hip score. 

[11]achieved fracture union by using two different kinds of internal fixation modality devices. The patients were treated with proximal femoral nailing (PFN) and/or dynamic hip screw (DHS) and were categorized randomly into two groups, each of 20 patients, 20 were treated by dynamic hip screw and 20 were treated with proximal femoral nail (PFN). As per the Harris hip score, in the DHS group overall, 5 patients had excellent results, 10 patients had good score, and 4 patients had fair results and 1 patient was recognized with poor score results. In the PFN group, 7 patients had excellent results, 12 patients had good score and 1 patient had fair and none had poor score results. 

[12]compared the results of treatment of unstable trochanteric fracture of femur in 40 patients treated by either PFN or DHS regarding primary outcomes: early mobilization, pain improvement, radiological assessment for fracture reduction and fixation and secondary outcome. This study was conducted on 40 patients with unstable peritrochanteric fractures treated surgically, where 20 patients were treated by DHS and 20 patients were treated by PFN. All were planned for follow-up examination for a period of 8 months from the date of operation. Full workup including the age, sex, medical history, type of fracture, mechanism of injury, and plain radiographs was carried out on admission. As per the Harris hip score, in the DHS group overall, three patients had excellent results, nine patients had good, six patients had fair results, and two had poor results. In the PFN group, six patients had excellent results, 12 patients had good, two patient had fair, and none had poor results. 

[13]assessed the clinical and radiographical outcomes of the DHS (load bearing implant) and PFN (load sharing implant) for the treatment of Intertrochanteric hip fractures. 52 cases of unstable femur fracture 26 operated with DHS and 26 with PFN were followed up with sequential radiographs for radiological union and sequential interview with Harris hip score calculation for functional outcome assessment. Patients operated for unstable intertrochanteric femur fracture with Proximal femoral nailing had better Harris hip scores (excellent 4, good 14) compared to dynamic hip screw group (Excellent 6, good 5) and earlier weight bearing (At 18 weeks, 100% in PFN compared to 65.5% in DHS). PFN has lesser incidence of postoperative complications (15% in PFN compared to 38% in DHS). The proximal femoral nail has better functional outcome in terms of Harris hip score and early radiologic union in unstable intertrochanteric fractures of femur. 

[14]compared operative management and functional outcome of femoral intertrochanteric fractures by dynamic hip screw v/s proximal femoral nail implants. During 2013 to 2016, 50 patients with intertrochanteric femur fracture were prospectively studied. Fractures included were AO type 31 A1 & A2. 25 patients each were taken in two groups DHS & PFN. These groups were compared for functional outcomes based on parameters: Harris hip score. The final functional outcome after 12 months assessed using Harris Hip Score showed excellent results in 11 patients in both the groups while a poor result was seen in 5 cases in the DHS and 1 case in the PFN group. Statistical difference was assessed using the Chi-square test. P value obtained was > 0.05, which was statistically not significant. The average Harris Hip Score was assessed, the score being 84.92 with standard deviation of 10.14 in the DHS group and 88.00 with standard deviation of 6.63 in the PFN group (statistically not significant). 11 cases (44%) in both the groups showed excellent results followed by good results in 7 cases of DHS and 11 cases of PFN. Poor results were seen in 5 cases of DHS and a single case of PFN. The result indicates no difference in the functional outcome between the two surgeries. 

[15]studied the functional evaluation using the modified Harris hip score after proximal femoral nail (PFN) in the treatment of intertrochanteric fractures. A prospective study done on 104 patients operated for intertrochanteric fractures with PFN. Patients were followed up at 6 weekly intervals and evaluated at each visit using the modified Harris hip score (HHS). The study consisted of 104 patients aged from 36 to 96 years with average age of 67.8 years. Most patients belonged to 60-80 years category. Malunion was observed in three patients (2.8%) and non union was not seen in any patient. Excellent to good results were seen in 73% patients 18% patients had a fair outcome, 7.7% had poor and 2% patients had very poor outcome. The assessment of results using HHS has been too similar to those obtained using Kyle’s criteria in the previous studies, proving its role in the same. 

[16]compared functional outcome of the intertrochanteric fracture of femur managed by Dynamic hip screw and proximal femoral nail. This Comparative Prospective study was conducted in a tertiary care institute ELMCH for a period of 18 months from January 2017 to June 2018. Every case with intertrochanteric fracture was treated randomly (computer generated number table) either by Dynamic hip screw (DHS) or Proximal femoral nail (PFN). A total of 80 cases were included. The patients were further divided into two groups, each of 40 cases, 40 were treated by Dynamic Hip Screw and 40 were treated with proximal femoral nail (P.F.N). All patients were followed up for nine months. The intergroup comparison of Harris Hip score between PFN and DHS group revealed that post operatively after 1 month the Harris hip score in PFN group had mean value 32.95±2.65, while the HH score in DHS group had mean 22.30±0.65. Post operatively after 3 month the Harris hip score in PFN group had mean value 57.33±2.10, while the HH score in DHS group had mean 51.90±0.96. Post operatively after 6 month the Harris hip score in PFN group had mean value 83.50±0.96, while the HH score in DHS group had mean 73.73±3.30. They concluded that PFN is better method of fixation in intertrochanteric fracture of femur. 

[17]compared proximal femoral nail and dynamic hip screw in the management of intertrochanteric fractures of femur. From November 2016 to October 2018, a prospective comparative study was done where 30 alternative cases of type III, IV intertrochanteric fractures of hip which were operated using PFN or DHS. Intraoperative complications were noted. The patients were followed up by assessing their functional ability with Harris Hip Score and fracture union by check x rays at 2, 4, 6 and 12 months postoperatively. 73% patients in both groups had good to excellent Harris Hip Score. Both groups were comparable in terms of functional outcome. 

[18]conducted a study to estimate the reliability of modified Harris Hip Score as a tool for outcome evaluation of Total Hip Replacements in Indian population. 101 patients with 122 hips for whom THR was done, were followed up, and Harris Hip Score and Modified Harris Hip Score (MHHS) were recorded at a minimum followup of 6 months. The mean MHHS was 78.97 with a standard deviation of 15.017. There was positive correlation between the two functional outcome scores with a p value of 0.001. MHHS was found to be reliable with a significant intraclass correlation coefficient (p = 0.001). They concluded that modified Harris Hip Score is a reliable and valid tool to measure functional outcome in patients undergoing Total Hip Replacements. 

[19]conducted a randomized controlled single-blind study compared proximal femoral nail and dynamic hip screw in the management of AO type A2 and A3 intertrochanteric fractures of femur. Patients treated with dynamic hip screw were enrolled in Group A, whereas the patients treated with proximal femoral nail were enrolled in Group B. Of the 68 patients, there were 34(50%) in each group.  The mean Harris hip score after 12 months in Groups A and B were 81.83±23.01 and 87.62±17.28 respectively. Infection was seen in 2(5.9%) patients in Group A and 1(2.9%) in Group B. The authors concluded that proximal femoral nail provided equivalent functional outcome compared to dynamic hip screw with lesser blood loss and surgical time. 

[20]validated the Harris Hip Score by conducting prospective study in which 310 patients were evaluated using Harris Hip Score and Medical Outcomes Study 12-Item Short-Form Health Survey as a generic health measure to test for construct validity, criterion validity, test-retest reliability, inter-observer reliability, and internal consistency reliability. The test-retest reliability and interobserver reliability were excellent with Goodman-Kruskal Gamma value of one. The internal consistency of the questionnaires was excellent with Cronbach’s alfa coefficient of 0.743. The Harris hip core was found to be reliable and responsive with acceptable construct and criterion validity. 

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

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