Comparison of distribution, agreement and correlation between the original and modified Merle d'Aubigné-Postel Score and the Harris Hip Score after acetabular fracture treatment: Moderate agreement, high ceiling effect and excellent correlation in 450 patients

Figures & data

Table 1.  Original Merle d'Aubigné-Postel Score. The individual scores of Pain, Walking ability and Mobility are added together to give an overall numeric score. Clinical grades (Very good, Good, Medium, Fair, Poor) are given by the scores of Pain and Walking ability and adjusted down 1–2 grades, depending on the mobility score (D'Aubigne and Postel 1954). The total numeric score was used in our study

Score	Pain	Walking ability	Mobility
0	Pain is intense and permanent	None	Ankylosis with bad position of the hip
1	Pain is severe, even at night	Only with crutches	No movement; pain or slight deformity
2	Pain is severe when walking; prevents any activity	Only with canes	Flexion under 40 degrees
3	Pain is tolerable with limited activity	With 1 cane, less than 1 h; very difficult	Flexion between 40 and 60 degrees
4	Pain is mild when walking; it disappears with rest	A long time with a cane; short time without cane and with limp	Flexion between 60 and 80 degrees; patient can reach his/her foot
5	Pain is mild and inconstant; normal activity	Without cane, but with slight limp	Flexion between 80 and 90 degrees; abduction of at least 15 degrees
6	No pain	Normal	Flexion more than 90 degrees; abduction to 30 degrees

Table 2.  Modified Merle d'Aubigné-Postel Score. The overall numeric score is given by adding the domain scores. Clinical grades: Excellent 18, Good 15–17, Fair 12–14, Poor 3–11 (Matta et al. 1986). The total numeric score was used in the present study

Score	Pain	Ambulation	ROM (%)
6	No pain	Normal	95–100
5	Slight or intermittent	No cane, but slight limp	80–94
4	Pain after ambulation, but disappears	Long distances with cane or crutch	60–79
3	Moderately severe, permits ambulation	Limited, even with support	40–59
2	Severe with ambulation	Very limited
1	Severe, prevents ambulation	Bedridden	0–39

Table 3.  The Harris Hip Score consists of the domains Pain, Function, Deformity and ROM, and gives a maximum of 100 points in the total score (Harris 1969)

Domain	Score
I Pain
A None or ignores it	44
B Slight, occasional, no compromise in activities	40
C Mild pain, no effect on average activities, rarely moderate pain with unusual activity, may take aspirin	30
D Moderate pain, tolerable but makes concessions to pain. Some limitation of ordinary activity or work. May require occasional pain medicine stronger than aspirin	20
E Marked pain, serious limitations of activities	10
F Totally disabled, crippled, pain in bed, bedridden	0
II Function
A Gait
1 Limp:  a None	11
b Slight	8
c Moderate	5
d Severe	0
2 Support: a None	11
b Cane for long walks	7
c Cane most of the time	5
d One crutch	3
e Two canes	2
f Two crutches	0
g Not able to walk	0
B Activities
1 Stairs:  a Normally without using any railing	4
b Normally using a railing	2
c In any manner	1
d Unable to use stairs	0
2 Shoes and socks:   a With ease	4
b With difficulty	2
c Unable	0
3 Sitting:
a Sitting comfortably in ordinary chair 1 h	5
b On a high chair for one-half hour	3
c Unable to sit comfortably in any chair	0
4 Distance: a Unlimited	11
b Six blocks	8
c Two or three blocks	5
d Indoors only	2
e Bed and chair	0
5 Enter public transportation	1
III Absence of deformity points (4) are given if the patient demonstrates:
A Less than 30° fixed flexion contracture
B Less than 10° fixed adduction
C Less than 10° fixed internal rotation in extension
D Limb-length discrepancy less than 3.2 cm
IV ROM (Index values are determined by multiplying the degrees of motion by the indices.The ROM score is given by adding the index values multiplying with the factor 0.05.Maximum score gives 5 points)
A Flexion: 0–45° × 1.0, 45–90° × 0.6, 90–110° × 0.3
B Abduction: 0–15° × 0.8, 15–20° × 0.3, < 20° × 0
C External rotation in extension: 0–15° × 0.4, <15° × 0
D Internal rotation in extension: any × 0
E Adduction: 0–15° × 0.2

Figure 1. The scatter plots between total numeric score of the Harris Hip Score and the original- and modified Merle d'Aubigné-Postel Scores show how well the scores conform to a straight line. Excellent correlations are apparent, but a defined value in one score may represent a considerable variation in the other score.

Table 4.  Spearman correlation coefficients between the domains in the three different outcome scores

Harris Hip Score	0.82	Original Merle d'Aubigné-Postel Score
Pain		0.81	Pain
Function			0.78	Walking ability
ROM				0.29	Mobility
Original Merle d'Aubigné-Postel Score	0.89	Modified Merle d'Aubigné-Postel Score
Pain		1.0	Pain
Walking ability			1.0	Ambulation
Mobility				0.31	ROM relative
Modified Merle d'Aubigné-Postel Score	0.81	Harris Hip Score
Pain		0.81	Pain
Ambulation			0.78	Function
ROM relative				0.33	ROM

Figure 2. The distributions of the 661 records in the three outcome scores (A – Harris Hip Score, B – Original Merle d'Aubigné-Postel Score, and C – Modified Merle d'Aubigné-Postel Score) were skewed with a left tail and demonstrated a considerable ceiling effect for all three.

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