The Hip Disability and Osteoarthritis Outcome Score, or HOOS, is a 40-item patient-reported outcome measure used to assess hip pain, symptoms, daily function, sport and recreation function, and hip-related quality of life. It can support monitoring and progress tracking for hip osteoarthritis, hip disability and post-operative hip recovery, but it does not diagnose a condition or determine return-to-activity readiness on its own.
Hip problems can affect walking, stairs, sitting, standing, squatting, running, sport, work tasks, sleep, confidence and quality of life.
The Hip Disability and Osteoarthritis Outcome Score, commonly called the HOOS, is a hip-specific patient-reported outcome measure designed to capture the client’s own view of their hip symptoms, function and quality of life.
It is commonly used for:
hip osteoarthritis
hip disability monitoring
total hip replacement or total hip arthroplasty follow-up
hip pain progress tracking
post-operative hip recovery
daily function monitoring
sport and recreation limitations
long-term outcome reporting
The HOOS includes five separately scored subscales: Pain, Symptoms, Activities of Daily Living, Sport and Recreation, and Hip-Related Quality of Life. Scores are transformed to a 0–100 scale, where 100 represents no hip problems and 0 represents extreme hip problems.
Outcome measure: Hip Disability and Osteoarthritis Outcome Score
Abbreviation: HOOS
Body region: Hip
Type: Patient-reported outcome measure
Number of items: 40
Subscales: Pain, Symptoms, Activities of Daily Living, Sport/Recreation, Quality of Life
Score range: 0–100 for each subscale
Higher score means: Better perceived hip status
Lower score means: More pain, symptoms, limitation or quality-of-life impact
Related versions: HOOS-12, HOOS-PS, HOOS-JR
Best used for: Baseline assessment, reassessment, progress tracking and outcome reporting
Key limitation: HOOS does not diagnose a condition or determine clearance on its own
The HOOS is a hip-specific patient-reported outcome measure.
It was developed to assess symptoms and functional limitations in people with hip disability and hip osteoarthritis. The original HOOS validation study evaluated its validity and responsiveness in people with primary hip osteoarthritis assigned for total hip replacement.
The five HOOS subscales are:
Pain
Other Symptoms
Activities of Daily Living
Sport and Recreation Function
Hip-Related Quality of Life
The HOOS includes all WOMAC questions in unchanged form, with additional items designed to capture hip-related problems beyond basic osteoarthritis symptoms.
The HOOS is used because physical tests alone do not always explain how a hip problem affects a client’s daily life, activity participation or quality of life.
A client may show improving strength or range of motion but still report:
pain with stairs
difficulty walking longer distances
trouble getting in and out of chairs or cars
stiffness after sitting
reduced sport or recreation participation
difficulty with socks, shoes or dressing
reduced confidence with movement
frustration with persistent symptoms
The HOOS can help professionals:
establish a baseline
identify which domains are most affected
monitor change over time
support client education
guide goal-setting conversations
compare symptoms and function across reassessments
combine client-reported outcomes with physical testing
improve reporting quality in Measurz
The HOOS should support assessment reasoning and progress tracking. It should not be used as a stand-alone diagnostic, treatment or clearance tool.
The Pain subscale captures hip pain during different activities and situations.
It may provide insight into pain during:
walking
stairs
standing
sitting
bending
twisting or pivoting
night-time or rest
The Symptoms subscale captures other hip-related symptoms.
This may include:
stiffness
restricted movement
grinding or clicking
symptom severity
movement-related discomfort
The ADL subscale captures day-to-day functional ability.
This may include:
walking
stairs
standing
sitting
getting in and out of a car
rising from sitting
putting on socks or shoes
household tasks
The Sport/Recreation subscale captures higher-demand activity.
This may include:
squatting
running
twisting
pivoting
recreational activity
sport participation
The Quality of Life subscale captures the broader impact of the hip problem.
This may include:
confidence
lifestyle impact
awareness of the hip
frustration
participation restriction
concerns about the future
The HOOS may be useful for:
exercise professionals
rehabilitation practitioners
strength and conditioning coaches
allied health support teams
movement assessment professionals
students learning outcome measures
professionals using Measurz or MAT for structured progress tracking
It may be relevant for clients with:
hip osteoarthritis
hip disability
hip pain
post-operative hip recovery
total hip replacement follow-up
reduced walking or stair tolerance
hip-related sport or recreation limitations
persistent stiffness, pain or quality-of-life impact
Use the HOOS when you want to understand how a hip problem affects the client’s pain, symptoms, function and quality of life.
It may be useful at:
initial assessment
onboarding
reassessment
hip osteoarthritis monitoring
post-operative milestones
pre- and post-total hip replacement monitoring
return-to-walking or return-to-activity planning
discharge or progress review
The HOOS is most useful when repeated over time using the same version and scoring method.
Use caution when:
the client cannot complete the questionnaire independently
literacy, language or cognitive factors affect responses
the wrong language version is being used
multiple body regions are contributing to limitation
the client has not attempted the activities being scored
many items are missing
the score is being used as a pass/fail decision
the result is interpreted without physical assessment context
The HOOS should not be used to:
diagnose hip osteoarthritis
confirm structural hip pathology
determine tissue healing
identify the exact cause of symptoms
clear someone for sport or activity
replace professional judgement
replace medical assessment when needed
HOOS questionnaire
Official scoring guide or validated calculator
Measurz recording workflow
Client-reported symptom and function notes
Baseline and retest dates
Optional related physical tests, such as:
hip range of motion
hip strength testing
gait assessment
sit-to-stand testing
step or stair assessment
single-leg balance
single-leg squat
walking tolerance
pain with key movements
Explain the purpose of the questionnaire before the client completes it.
Example wording:
“This questionnaire helps us understand how your hip is affecting your pain, symptoms, daily function, sport and quality of life. It does not diagnose the problem on its own, but it helps us monitor change over time.”
The HOOS can be completed:
on paper
digitally
independently
with assistance
before a session
during reassessment
as part of a Measurz workflow
Ask the client to:
answer based on their current hip problem
choose the response that best matches their experience
answer every item where possible
avoid overthinking each question
ask for clarification if they do not understand the wording
complete the same version at each retest
Record whether the HOOS was completed:
independently
digitally
on paper
verbally
with assistance
This matters because assistance, wording clarification or completion format may influence responses.
If help is required:
explain the instructions without leading the answer
avoid telling the client which response to choose
record that assistance was provided
use the same assistance approach at retest where possible
Do not guess missing responses.
Use the official scoring guidance for the version being used. If too many items are missing for a subscale, record that subscale as incomplete rather than creating an unreliable score.
Each HOOS item is scored from 0 to 4.
Each subscale is transformed to a 0–100 score.
General scoring direction:
100: no hip problems
0: extreme hip problems
The five subscales should be interpreted separately rather than combined into one unsupported total score.
Retest at meaningful time points, such as:
baseline
after a training block
after a rehabilitation phase
after a flare-up
pre-surgery or post-surgery milestone
post-operative review
discharge or progress review
For consistency, record:
date
current activity level
recent flare-ups
recent training load
walking exposure
stair exposure
whether the client has returned to activities being scored
any major changes in work, sport or daily demands
The HOOS is a self-report questionnaire, so it does not create physical testing risk.
However, a major worsening in score may support further assessment if the client reports:
severe deterioration
major quality-of-life impact
worsening function
severe pain
unexpected decline
new or changing symptoms
The HOOS has five separate subscale scores.
Each subscale ranges from 0 to 100.
Higher scores indicate better perceived hip status.
Lower scores indicate more reported problems.
Pain: 0–100
Symptoms: 0–100
Activities of Daily Living: 0–100
Sport/Recreation: 0–100
Quality of Life: 0–100
A higher score may suggest:
less hip pain
fewer hip symptoms
better daily function
better sport or recreation function
better hip-related quality of life
improved confidence with hip-related activity
A lower score may suggest:
more pain
more symptoms
reduced daily function
reduced sport or recreation capacity
reduced confidence
greater hip-related quality-of-life impact
A HOOS score does not prove:
the diagnosis
the tissue source of symptoms
the severity of structural change
readiness to return to sport or activity
whether imaging is required
whether a specific intervention caused the change
Example wording:
“Your HOOS results suggest your daily function is improving, but your pain and quality-of-life scores are still affected. This does not tell us exactly what structure is causing symptoms, but it helps us understand how your hip is affecting the activities that matter to you.”
For general fitness clients, HOOS can help show how hip symptoms affect:
walking
stairs
sitting
standing
gym training
recreational exercise
daily activity
Interpretation cautions:
scores may change with recent activity
symptoms from the low back, knee or pelvis may affect answers
sport items may be less relevant if the client does not participate in sport
For sport and performance clients, Sport/Recreation and Quality of Life may be especially important.
A client may report limitations with:
running
squatting
twisting
pivoting
gym training
change of direction
confidence with sport-specific movement
Interpretation should include sport-specific testing. A high HOOS score should not be treated as clearance on its own.
For older adults and people with hip osteoarthritis, HOOS may help monitor:
pain
stiffness
walking tolerance
stair tolerance
quality of life
daily function
Interpretation cautions:
other health conditions may affect scores
general strength and balance may influence function
walking exposure and activity level should be recorded
broad reference values should be used cautiously
Standard HOOS is not primarily designed as a youth measure.
For youth clients, consider:
reading level
comprehension
parent or guardian assistance
sport exposure
whether a youth-specific or hip-specific measure may be more appropriate
If assistance is provided, record it clearly.
HOOS is especially relevant for hip osteoarthritis because it was developed and validated for hip disability and osteoarthritis contexts.
Interpretation should consider:
flare-ups
medication changes
activity exposure
walking tolerance
stair function
strength and range of motion
quality-of-life impact
For total hip replacement or total hip arthroplasty, HOOS can help track changes before and after surgery.
Interpretation should consider:
surgery date
post-operative stage
restrictions
walking exposure
pain medication
expected recovery timeline
medical or surgical guidance where relevant
The original validation study found the HOOS met validity and responsiveness criteria in people with primary hip osteoarthritis assigned for total hip replacement.
For persistent hip symptoms, HOOS can help monitor broader impact beyond pain.
Scores may be influenced by:
confidence
activity avoidance
expectations
flare-up patterns
participation restrictions
quality-of-life impact
Meaningful change values help interpret whether a score change is likely to matter.
Key terms:
MCID / MIC: the smallest change that may be meaningful to clients or professionals, depending on the method used
MDC: the amount of change likely needed to exceed measurement error
SEM: the estimated measurement error around a score
Responsiveness: the ability of the measure to detect change over time
PASS: patient acceptable symptom state
SCB: substantial clinical benefit
Meaningful change values for HOOS vary depending on the population, HOOS version, subscale and clinical context.
A 2024 systematic review examined MCID, MIC, CID, MDC and PASS values for commonly used PROMs after total hip arthroplasty. This is relevant for THA settings but should not be applied automatically to non-surgical hip pain or sport populations.
Recent work has also examined short-term MCID values for HOOS after total hip arthroplasty at 3 and 6 months, using an anchor-based approach. Those values are specific to the study’s THA population and timeframe.
When interpreting HOOS change:
compare each subscale to baseline
use population-specific MCID, MIC, MDC or SEM where available
avoid applying one universal threshold to every hip presentation
look for consistent improvement across relevant subscales
compare score change with client goals
check whether activity exposure has increased
consider pain, strength, range of motion and functional tests
Reported meaningful change values may vary by:
condition
age
surgery type
non-surgical versus surgical care
subscale
language version
follow-up timeframe
anchor method
baseline severity
When no matching value exists, interpretation should rely more heavily on:
baseline comparison
repeated measurement
client-reported change
physical assessment findings
activity exposure
professional judgement
Published HOOS reference values are available, but they should be applied carefully.
A 2023 Danish population-based study established reference values for the five HOOS subscales and HOOS-12 using a representative sample of Danish citizens aged 18 years and older. The study noted that reference data can improve interpretation of HOOS and HOOS-12 scores.
Earlier population-based reference work also reported that hip complaints differ across age and sex, supporting the need to interpret HOOS scores with demographic context rather than as one universal cut-off.
Reference values provide context, but interpretation should consider whether the reference population matches the client’s:
age
sex
country
health status
hip osteoarthritis status
BMI
activity level
sport or work demands
surgical history
Practical guidance:
Scores closer to 100 generally suggest fewer reported hip problems.
Lower scores suggest greater pain, symptoms, functional limitation or quality-of-life impact.
Sport/Recreation and Quality of Life may remain limited after ADL improves.
Population reference values provide context, not strict pass/fail thresholds.
The client’s own baseline is often the most useful comparison.
The HOOS has post-2000 evidence supporting its use across hip osteoarthritis and total hip replacement contexts.
The original HOOS validation study evaluated people with primary hip osteoarthritis assigned for total hip replacement and found that HOOS met criteria for validity and responsiveness.
A large validation study of HOOS and KOOS pain and function subscales in total hip and total knee replacement found evidence supporting construct validity for HOOS/KOOS pain and ADL function measures in these surgical populations.
More recent research has examined HOOS psychometrics in large registry data after total hip arthroplasty, reflecting ongoing interest in structural validity and measurement quality for HOOS and related versions.
Reliability and validity are stronger when:
the correct HOOS version is used
the same scoring method is repeated
all relevant items are completed
subscales are interpreted separately
the correct language version is used
retesting occurs at meaningful time points
results are interpreted alongside physical and functional assessment
Interpret cautiously when:
many items are missing
the client has not attempted sport or work tasks yet
only one subscale changes slightly
the change is smaller than known measurement error or meaningful change
symptoms are strongly influenced by a recent flare-up
the score is being used without objective assessment context
Common errors include:
treating HOOS as a diagnosis
using HOOS as return-to-sport or return-to-activity clearance
combining subscales into one unsupported total score
ignoring missing items
using inconsistent scoring methods
not recording the version used
not recording the completion date
comparing scores without considering activity exposure
over-interpreting small changes
using reference values as strict pass/fail cut-offs
Limitations include:
self-report can be influenced by mood, expectations and recent activity
sport items may be less meaningful if the client has not returned to sport
scores do not identify the exact physical cause of symptoms
meaningful change values vary by condition and population
reference values may not match the client’s age, activity level or condition
HOOS should be paired with physical tests and client goals
The HOOS may help professionals:
document baseline hip status
identify whether pain, symptoms, daily function, sport or quality of life are most affected
track change over time
monitor hip osteoarthritis symptoms
monitor post-operative hip recovery
support goal setting
improve client education
communicate progress with a broader team
strengthen Measurz reports
For older adults or people with hip osteoarthritis, HOOS can help monitor walking, stairs, stiffness, pain and quality-of-life impact.
For post-surgical clients, HOOS can help track self-reported progress after total hip replacement when interpreted with recovery stage and professional guidance.
For active clients, HOOS can highlight whether sport and recreation remain limited despite improvements in daily function.
For Measurz users, HOOS is most useful when combined with objective measures such as:
hip range of motion
hip strength
walking tolerance
sit-to-stand testing
stair assessment
single-leg balance
gait assessment
pain with key movements
Record:
outcome measure name: Hip Disability and Osteoarthritis Outcome Score / HOOS
version used: HOOS, HOOS-12, HOOS-PS, HOOS-JR or other
date completed
completion method: paper, digital, interview or assisted
language/version used
condition or presentation being tracked
side involved: left, right or bilateral
Pain subscale score
Symptoms subscale score
ADL subscale score
Sport/Recreation subscale score
Quality of Life subscale score
score range: 0–100
direction of scoring: higher score indicates better status
missing items, if any
assistance provided, if any
current pain score, if relevant
current symptoms
current activity or sport exposure
walking or stair exposure
key functional limitations
confidence or participation goals
baseline comparison
MCID/MDC/MIC/PASS comparison where supported
related physical assessment findings
interpretation notes
retest date
referral or further assessment notes where appropriate
Record whether the main limitation appears to be:
pain dominant
symptom or stiffness dominant
daily function limitation
sport/recreation limitation
quality-of-life limitation
mixed presentation
unclear due to incomplete responses
This improves:
repeatability
communication
client education
assessment reasoning
monitoring over time
team consistency
reporting quality
The HOOS measures self-reported hip pain, symptoms, daily function, sport and recreation function, and hip-related quality of life.
The full HOOS has 40 items across five subscales.
Each subscale is converted to a 0–100 score. A higher score indicates better perceived hip status.
HOOS is usually interpreted using five separate subscale scores rather than one combined total score.
No. HOOS does not diagnose hip osteoarthritis or any other hip condition. It measures the client’s perceived symptoms, function and quality-of-life impact.
Meaningful change depends on the population, condition, subscale and HOOS version. Use MCID, MIC, MDC, SEM or PASS values only when they match the client group and context.
Yes. HOOS is commonly used in total hip replacement and total hip arthroplasty contexts, but results should be interpreted with recovery stage, medical guidance and physical findings.
HOOS can support return-to-activity reasoning, especially the Sport/Recreation and Quality of Life subscales, but it should not be the only clearance measure.
HOOS is a 40-item hip-specific patient-reported outcome measure.
It includes Pain, Symptoms, ADL, Sport/Recreation and Quality of Life subscales.
Each subscale is scored from 0 to 100.
Higher scores indicate better perceived hip status.
HOOS does not diagnose hip osteoarthritis or clear a client for sport or activity.
Meaningful change values should be matched to the population, subscale and context.
Published reference values are available, but they should be used as context rather than strict pass/fail standards.
Measurz should record each subscale, version, completion method, side, baseline comparison, related findings and retest plan.
Braaksma, C., Leclercq, W. K. G., Tordoir, R. L., et al. (2020). Systematic review and meta-analysis of measurement properties of the Hip disability and Osteoarthritis Outcome Score - Physical function Shortform (HOOS-PS) and the Knee Injury and Osteoarthritis Outcome Score - Physical function Shortform (KOOS-PS). Osteoarthritis and Cartilage, 28(12), 1525–1538. https://doi.org/10.1016/j.joca.2020.09.005
Larsen, P., et al. (2023). National population-based reference data for the Hip Disability and Osteoarthritis Outcome Score (HOOS). Archives of Orthopaedic and Trauma Surgery. https://doi.org/10.1007/s00402-023-04915-w
Nilsdotter, A. K., Lohmander, L. S., Klässbo, M., & Roos, E. M. (2003). Hip disability and Osteoarthritis Outcome Score (HOOS): Validity and responsiveness in total hip replacement. BMC Musculoskeletal Disorders, 4, 10. https://doi.org/10.1186/1471-2474-4-10
Sundén, A., Lidengren, K., Roos, E. M., Lohmander, L. S., & Ekvall Hansson, E. (2018). Hip complaints differ across age and sex: A population-based reference data for the Hip disability and Osteoarthritis Outcome Score (HOOS). Health and Quality of Life Outcomes, 16, 200. https://doi.org/10.1186/s12955-018-1022-8
Tangtrakulwanich, B., et al. (2026). Minimal clinically important difference in the Hip disability and Osteoarthritis Outcome Score at 3 and 6 months after total hip arthroplasty. Journal of Orthopaedic Surgery. https://doi.org/10.1177/10225536261433423
Wylde, V., et al. (2024). Clinical relevance of patient-reported outcome measures in total hip arthroplasty: A systematic review of MCID, MIC, CID, MDC and PASS. Archives of Orthopaedic and Trauma Surgery. https://doi.org/10.1007/s00402-024-05579-w
