Copenhagen Hip Score: Understanding Its Purpose, Components, and Clinical Importance

What is the Copenhagen hip score?

The Copenhagen Hip Score (CHS) is a patient-reported outcome measure (PROM) designed to assess pain, symptoms, function, and quality of life in individuals, primarily those undergoing hip preservation surgery, particularly for femoroacetabular impingement (FAI).

Understanding the Copenhagen Hip Score: An Overview

The Copenhagen Hip Score (CHS) stands as a crucial tool in the comprehensive evaluation of hip health, particularly within the realm of hip preservation. Developed in Copenhagen, Denmark, this standardized questionnaire serves as a patient-reported outcome measure (PROM), meaning it directly captures the individual's subjective experience of their hip condition. Unlike objective clinical tests or imaging, the CHS provides invaluable insight into how hip pain and dysfunction impact a person's daily life, activities, and overall well-being. Its primary application lies in monitoring the progress and effectiveness of interventions, especially surgical procedures for conditions like femoroacetabular impingement (FAI) and labral tears.

Components of the Copenhagen Hip Score (CHS)

The CHS is a multi-item questionnaire that typically consists of several questions categorized into distinct domains, providing a holistic view of the patient's hip status. While the exact number of questions can vary slightly depending on the version (e.g., short form), the core domains assessed include:

• Pain: Questions directly addressing the severity, frequency, and nature of hip pain experienced by the individual.
• Symptoms: Queries related to other hip-specific symptoms such as clicking, catching, locking, or stiffness.
• Function: This critical domain evaluates the patient's ability to perform various activities of daily living (ADLs) and sports-related movements, such as walking, running, squatting, ascending/descending stairs, and participating in recreational or competitive sports.
• Quality of Life: Questions that delve into the broader impact of the hip condition on the individual's emotional well-being, social interactions, and overall quality of life.

Each question is scored on a pre-defined scale, and these scores are then summed to yield a total score, typically ranging from 0 to 100. A higher total score on the Copenhagen Hip Score indicates better hip function, less pain, and a higher quality of life.

Why is the CHS Important?

The significance of the Copenhagen Hip Score in clinical practice and research cannot be overstated:

• Patient-Centered Assessment: It shifts the focus from purely objective clinical findings to the patient's lived experience, providing a vital perspective on the true impact of their condition and the effectiveness of treatment.
• Tracking Progress and Outcomes: By administering the CHS at baseline (pre-intervention) and at various follow-up intervals (post-intervention), clinicians can objectively track improvements or declines in the patient's condition over time. This is crucial for evaluating treatment efficacy.
• Research and Clinical Utility: The CHS provides a standardized, quantifiable measure for researchers to compare outcomes across different studies, surgical techniques, or rehabilitation protocols. In clinical settings, it aids in shared decision-making and helps justify interventions.
• Identifying Specific Impairments: The multi-domain structure allows clinicians to pinpoint specific areas where the patient is experiencing the most significant challenges (e.g., primarily pain, or significant functional limitations in sport), guiding more targeted rehabilitation strategies.

Administration and Interpretation

The Copenhagen Hip Score is typically a self-administered questionnaire, meaning patients complete it on their own, either in a clinic setting or remotely. This ease of administration makes it a practical tool for routine use.

Scoring: Once completed, the responses are converted into numerical scores for each question, and these are summed to derive a total score. Most commonly, the total score ranges from 0 to 100, where:

• 0: Represents the worst possible hip function and quality of life.
• 100: Represents the best possible hip function and quality of life.

Interpretation: Interpreting the CHS score requires context. While a higher score is always better, it's important to consider:

• Baseline Score: Improvement is measured relative to the patient's initial score.
• Minimal Clinically Important Difference (MCID): This refers to the smallest change in score that a patient perceives as beneficial. Knowing the MCID helps determine if an observed improvement is truly meaningful.
• Comparison to Normative Data: In some cases, scores can be compared to established normative data for healthy populations or specific patient groups, though this is less common for the CHS than for some other PROMs.

Target Population and Clinical Applications

The Copenhagen Hip Score is primarily validated and utilized in specific patient populations:

• Hip Preservation Patients: Its most common and effective use is with individuals suffering from hip pain due to conditions requiring hip preservation surgery, such as:
  • Femoroacetabular Impingement (FAI): Both cam and pincer types.
  • Labral Tears: Tears of the acetabular labrum.
  • Hip Dysplasia: In some cases where preservation strategies are employed.
  • Other Hip Arthroscopy Procedures: Used to assess outcomes following various minimally invasive hip surgeries.
• Monitoring Non-Surgical Management: While primarily used for surgical outcomes, the CHS can also be a valuable tool for tracking the effectiveness of conservative, non-surgical management strategies, such as physical therapy, for hip conditions.

Limitations and Considerations

While a powerful tool, the Copenhagen Hip Score, like any assessment instrument, has its limitations:

• Specificity: It is largely designed and validated for hip preservation pathologies (e.g., FAI, labral tears) and may not be as sensitive or appropriate for other hip conditions like advanced osteoarthritis or systemic inflammatory arthropathies.
• Subjectivity: As a patient-reported measure, it relies on the individual's perception, which can be influenced by psychological factors, pain tolerance, and expectations.
• Cultural and Linguistic Adaptations: For use in diverse populations, the CHS should ideally be culturally adapted and linguistically validated to ensure its accuracy and relevance.
• Not a Diagnostic Tool: It is crucial to remember that the CHS is an outcome measure, not a diagnostic tool. It cannot definitively diagnose a hip condition but rather quantifies its impact and monitors changes. Clinical diagnosis always requires a comprehensive medical history, physical examination, and appropriate imaging.

Conclusion

The Copenhagen Hip Score stands as an indispensable patient-reported outcome measure in the field of hip health, particularly for individuals navigating hip preservation challenges. By providing a structured and quantifiable assessment of pain, symptoms, function, and quality of life from the patient's perspective, the CHS empowers clinicians to make more informed decisions, track treatment efficacy, and ultimately enhance the holistic care provided to those with hip conditions. Its continued use underscores the shift towards patient-centered care and evidence-based practice in modern orthopedics and rehabilitation.