Hospital for Special Surgery Develops Hip and Knee Replacement Measurement Survey

New York, NY—February 29, 2016

Stephen Lyman, PhDHospital for Special Surgery (HSS), a world leader in orthopedics, validated two new shortened questionnaires that will significantly reduce the time it takes to collect patient-reported outcome data for hip and knee replacement surgeries, two of the most common and costliest hospital procedures. Beginning in April, Medicare will incentivize hospitals, participating in the Comprehensive Care for Joint Replacement model, an initiative aiming to support higher quality, more efficient care for patients undergoing hip and knee replacements, to voluntarily submit patient-reported outcome data.

"Patient reported outcomes are a valuable measurement tool to help assess whether the services provided actually improved patients' health and sense of well-being," said lead author Stephen Lyman, PhD, Director of the HSS Healthcare Research Institute. "These hip and knee replacement surveys are more efficient and accurate quality measurement tools to help orthopedic care, while significantly reducing the burden of outcome data collection."

With Medicare and other payers rapidly moving toward pay-to-performance outcomes, patient reported outcome measurement tools are becoming increasingly important. Beyond saving clinicians time, the new questionnaires were designed to help orthopedic surgeons better identify optimal surgery candidates, improve rehabilitation services and more effectively evaluate implant devices. In addition, the survey results will be available to consumers on - marking the first time treatment-specific, patient-reported outcomes data will be publicly available.

Patient-reported outcomes tools measure what patients are able to do and how they feel by asking questions. The Hip disability and Osteoarthritis Outcome Score (HOOS) JR.—a six-question hip survey—and the Knee injury and Osteoarthritis Outcome Score (KOOS) JR.—a seven-question knee survey—were developed by a multidisciplinary team from Hospital for Special Surgery as abbreviated versions of the existing HOOS and KOOS surveys (40 and 42 questions respectively).

The surveys were first validated at HSS, a tertiary care musculoskeletal specialty hospital in a dense urban area. For external validation, the Agency for Healthcare research and Quality-funded FORCE-TJR registry confirmed the validity of the surveys for the U.S. population and performed very well in the FORCE-TJR registry population.

In August 2015, a consensus that included the American Academy of Orthopedic Surgeons, American Association of Hip and Knee Surgeons, American Joint Replacement Registry, The Hip Society and The Knee Society recommended that HOOS, JR. and KOOS, JR. surveys should be the disease-specific patient survey instruments used by Medicare.

"We saw a need for a shorter, non-proprietary tool that is directly relevant to patients undergoing hip and knee replacement and capture more complete data, while reducing the administrative burden put on providers," said Dr. Lyman. "We are pleased that Medicare and the orthopedic community have embraced these tools to obtain more relevant patient information that can help improve outcomes."

HSS conducts 9,000 joint replacements annually, and performs more Medicare joint replacements than any other hospital in the United States. Orthopedic surgeons at HSS wanted a shorter patient survey that could more reliably be completed in the clinic waiting room and directly relevant to hip and knee replacement. In addition, patients were not filling out the longer surveys completely; leaving physicians with a lot of unusable information. These shorter versions of a validated survey address both of these concerns.

Evidence validating the new questionnaires was published online on February 29 in Clinical Orthopaedics and Related Research. Both outcome surveys are available at




About Hospital for Special Surgery
Hospital for Special Surgery (HSS) is the world’s largest academic medical center focused on musculoskeletal health. HSS is nationally ranked No. 1 in orthopedics and No. 2 in rheumatology by U.S. News & World Report (2016-2017), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. HSS has one of the lowest infection rates in the country. HSS is an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at


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