Oxford Hip Score

If you have been advised by the practice to submit an Oxford Hip Score please use this form.

Score Grading

• Score 0 to 19 – May indicate severe hip arthritis. It is highly likely that you may well require some form of surgical intervention, contact your family physician for a consult with an Orthopaedic Surgeon.
• Score 20 to 29 – May indicate moderate to severe hip arthritis. See your family physician for an assessment and x-ray. Consider a consult with an Orthopaedic Surgeon.
• Score 30 to 39 – May indicate mild to moderate hip arthritis. Consider seeing you family physician for an assessment and possible x-ray. You may benefit from non-surgical treatment, such as exercise, weight loss, and /or anti-inflammatory medication.
• Score 40 to 48 – May indicate satisfactory joint function. May not require any formal treatment.

Oxford Hip Score

Oxford Hip Score

If you are human, leave this field blank.

Please only complete this form if you have been specifically requested to do so. Any submitted forms that have not been requested by a Medical Professional will be voided.

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Email Address: *

Any responses we send will go to this email address.

During the past 4 weeks...

How would you describe the pain you usually have in your hip? *

None

Very mild

Mild

Moderate

Severe

Have you been troubled by pain from your hip in bed at night? *

No nights

Only 1 or 2 nights

Some nights

Most nights

Every night

Have you had any sudden, severe pain (shooting, stabbing, or spasms) from your affected hip? *

No days

Only 1 or 2 days

Some days

Most days

Every day

Have you been limping when walking because of your hip? *

Rarely/Never

Sometimes or just at first

Often, not just at first

Most of the time

All of the time

For how long have you been able to walk before the pain in your hip becomes severe (with or without a walking aid)? *

No pain for 30 minutes or more

16 to 30 minutes

5 to 15 minutes

Around the house only

Not at all

Have you been able to climb a flight of stairs? *

Yes, easily

With little difficulty

With moderate difficulty

With extreme difficulty

No, impossible

Have you been able to put on a pair of socks, stockings or tights? *

Yes, easily

With little difficulty

With moderate difficulty

With extreme difficulty

No, impossible

After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your hip? *

Not at all painful

Slightly painful

Moderately painful

Very painful

Unbearable

Have you had any trouble getting in and out of a car or using public transportation because of your hip? *

No trouble at all

Very little trouble

Moderate trouble

Extreme difficulty

Impossible to do

Have you had any trouble with washing and drying yourself (all over) because of your hip? *

No trouble at all

Very little trouble

Moderate trouble

Extreme difficulty

Impossible to do

Could you do the household shopping on your own? *

Yes, easily

With little difficulty

With moderate difficulty

With extreme difficulty

No, impossible

How much has pain from your hip interfered with your usual work, including housework? *

Not at all

A little bit

Moderately

Greatly

Totally

Your Oxford Hip Score is:

*

I confirm that the information provided is accurate to the best of my knowledge