SynthesisActa orthopaedica2010
The Harris hip score: Do ceiling effects limit its usefulness in orthopedics?
Synthesis in Acta orthopaedica, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04075461 (Is arthroplaSty bEtter Than interNal Fixation in the undiSplaced Femoral nEck Fracture? A National Pragmatical Randomized Controlled Trial - the SENSE Trial), which is not on this map. Cited by 104 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Is arthroplaSty bEtter Than interNal Fixation in the undiSplaced Femoral nEck Fracture? A National Pragmatical Randomized Controlled Trial - the SENSE Trial
Who cites it
104 citing papers in PubMed, 6 syntheses or guidelines pooled it, 251 citations in OpenAlex.
- What patient reported outcome measures are used in clinical trials in hip fracture? A systematic mapping review.BMC musculoskeletal disorders · 2026Pooled it
- Total hip arthroplasty in adolescents: a systematic review and meta-analysis.International orthopaedics · 2024Pooled it
- Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis.Archives of orthopaedic and trauma surgery · 2022Pooled it
- Estimates of the mean difference in orthopaedic randomized trials: obligatory yet obscure.BMC medical research methodology · 2021Pooled it
- Surgical intra- and extra-articular anterior cruciate ligament reconstruction: a meta-analysis.BMC musculoskeletal disorders · 2020Pooled it
- Instruments to assess patients with rotator cuff pathology: a systematic review of measurement properties.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2012Pooled it
- Trial
- Arthroscopic hip surgery compared with personalised hip therapy in people over 16 years old with femoroacetabular impingement syndrome: UK FASHIoN RCT.Health technology assessment (Winchester, England) · 2022Trial
- Developing a smartphone application, triaxial accelerometer-based, to quantify static and dynamic balance deficits in patients with cerebellar ataxias.Journal of neurology · 2020Trial
- High risk of positive Trendelenburg test after using the direct lateral approach to the hip compared with the anterolateral approach: a single-centre, randomized trial in patients with femoral neck fracture.The bone & joint journal · 2019Trial
- Do Postoperative Results Differ in a Randomized Trial Between a Direct Anterior and a Direct Lateral Approach in THA?Clinical orthopaedics and related research · 2019Trial
- 5-year clinical and radiographic follow-up of the uncemented Symax hip stem in an international study.Journal of orthopaedic surgery and research · 2018Trial
- A prospective randomized comparison of the minimally invasive direct anterior and the transgluteal approach for primary total hip arthroplasty.BMC musculoskeletal disorders · 2018Trial
- HOPE-trial: hemiarthroplasty compared to total hip arthroplasty for displaced femoral neck fractures in the elderly-elderly, a randomized controlled trial.BMC musculoskeletal disorders · 2015Trial
- Percutaneous compression plate versus proximal femoral nail anti-rotation in treating elderly patients with intertrochanteric fractures: a prospective randomized study.Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association · 2013Trial
- Risk factors for delayed gait recovery after primary total hip arthroplasty in patients with crowe type I/II developmental dysplasia of the hip.BMC surgery · 2026Article
- MAKO Robotic-Arm-Assisted Versus Conventional Dual-Incision Total Hip Arthroplasty: A Propensity-Score-Matched Retrospective Study.Journal of clinical medicine · 2026Article
- Validation of the Caprini risk assessment model and efficacy of perioperative nutritional support + preventive nursing in reducing DVT among high-risk older adults undergoing hip fracture surgery: a two-phase study.Frontiers in medicine · 2026Article
- Case Report: Proximal femoral valgus osteotomy and dynamic hip screw fixation for post-traumatic coxa vara secondary to femoral neck or intertrochanteric fracture nonunion or malunion: a retrospective case series.Frontiers in surgery · 2026Article
- Gait Recovery After Total Hip Arthroplasty with Subtrochanteric Osteotomy in Highly Dislocated Hips: A Retrospective Single-Center Cohort Study.Journal of clinical medicine · 2025Article
44 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeThe Harris hip score (HHS), a disease-specific health status scale that is frequently used to measure the outcome of total hip arthroplasty, has never been validated properly. A questionnaire is suitable only when all 5 psychometric properties are of sufficient quality. We questioned the usefulness of the HHS by investigating its content validity.
methodsWe performed a systematic review based on a literature search in PubMed, Embase, and the Cochrane Library for descriptive studies published in 2007. 54 studies (59 patient groups) met our criteria and were included in the data analysis. To determine the content validity, we calculated the ceiling effect (percentage) for each separate study and we pooled data to measure the weighted mean. A subanalysis of indications for THA was performed to differentiate the populations for which the HHS would be suitable and for which it would not. A ceiling effect of 15% or less was considered to be acceptable.
resultsOver half the studies (31/59) revealed unacceptable ceiling effects. Pooled data across the studies included (n = 6,667 patients) suggested ceiling effects of 20% (95%CI: 18-22). Ceiling effects were greater (32%, 95%CI:12-52) in those patients undergoing hip resurfacing arthroplasty.
interpretationAlthough the Harris hip score is widely used in arthroplasty research on outcomes, ceiling effects are common and these severely limit its validity in this field of research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.