Reliability of the Harris Hip Score among Observers in the Management of Femoral Neck Fracture

A BSTRACT Background: Femoral neck fractures (FNFs) account for many hip fractures. Reliable measures are essential for evaluating treatment effectiveness and functional outcomes. Harris Hip Score (HHS) is designed to evaluate hip function and measure the success of hip surgery. Objective: This study intends to investigate the intra- and inter-observer reliability of the HHS among orthopedic consultants managing FNFs. Materials and Methods: A prospective cohort study was conducted from November 2021 to November 2023 at King Khalid Hospital in Hail, Saudi Arabia. Patients aged 18 years and older with unilateral FNFs treated with closed reduction and percutaneous cannulated screws were included in the study. Six orthopedic consultants performed assessments using the HHS, with each patient evaluated twice. The same observer performed this task to determine intra-observer reliability, while different observers were used to assess inter-observer reliability, organized in a 2:1 ratio, respectively, depending on consultant availability, with two observers present at each clinic day. Reliability was determined through the use of the Kendall coefficient of concordance. Results: A total of 45 patients participated, with an average age of 31.27 years. The study indicated strong inter-observer reliability, featuring Kendall W values of 0.89, 0.87, and 0.90, alongside robust intra-observer reliability, with W values of 1.00, 0.90, 0.96, 0.82, 1.00, and 0.94 among the orthopedic consultants, reflecting consistent scoring throughout the assessments. Conclusion: The HHS exhibits high reliability in assessing patients with FNFs. This study supports the use of HHS as a robust tool in clinical practice for evaluating treatment outcomes.