Demographic Biases Found in Scoring Instruments of Total Hip Arthroplasty

   Currently, approximately 120,000 primary total hip arthroplasties (THAs) are performed in North America each year [1]. With the increasing concerns related to the rising cost of health care (and the need for cost containment and cost-effectiveness), there has been a growing interest in outcome studies [2-4], and the need for validatedscoring instruments as a means of measuring outcomes has been recognized [5-101. Over the past four decades, numerous scoring systems have been used to assess the preoperative and postoperative status of individuals undergoing THA by assigning numerical scores based on a variety of factors, including pain, function, activities, and range of motion. These numerically based instruments have provided a basis for comparison of differing disease processes, patient populations, and types of treatment. Because these scoring systems are relatively convenient to use, they have enjoyed widespread approval throughout the orthopaedic community and have been the gold standard for clinical investigation of hip arthroplasty over the last 30 years. A number of recent studies, however, have critically analyzed various commonly used hip scoring...