Evaluate Your Pain

It’s critical to understand, monitor, and judge the level of your knee pain and current functionality, so that you and your doctor can assess whether a knee replacement or other treatment is right for you. The questions below will help you and your clinician understand the severity of your condition.

On each question, rate yourself on a scale of 1 to 5. When totaled, your score will tell you whether you’re a potential candidate for a total or partial knee replacement. Consider printing the questionnaire and marking your responses so that you can share it with your doctor.

1. Your overall level of pain:

1 = slight pain and/or no trouble

2 = slight pain and/or little trouble

3 = moderate pain and/or moderate trouble

4 = serious pain and/or extreme difficulty

5 = severe pain and/or impossible

2. Pain and difficulty bathing and drying yourself:

1 = slight pain and/or no trouble

2 = slight pain and/or little trouble

3 = moderate pain and/or moderate trouble

4 = serious pain and/or extreme difficulty

5 = severe pain and/or impossible

3. Pain and difficulty getting in and out of a car, operating the vehicle, or using public transportation:

1 = slight pain and/or no trouble

2 = slight pain and/or little trouble

3 = moderate pain and/or moderate trouble

4 = serious pain and/or extreme difficulty

5 = severe pain and/or impossible

4. Indicate the length of time you’re able to walk before experiencing severe knee pain (with or without a cane):

1 = > 30 minutes

2 = 16-30 minutes

3 = 5-15 minutes

4 = less than 5 minutes

5 = can’t walk without severe pain

5. After sitting in a chair or at a table and then getting up to stand, what level of pain do you experience?

1 = slight pain and/or no trouble

2 = slight pain and/or little trouble

3 = moderate pain and/or moderate trouble

4 = serious pain and/or extreme difficulty

5 = severe pain and/or impossible

7. Are you able to kneel down and get back up easily afterwards?

1 = yes, without any problem

2 = yes, with slight difficulty

3 = yes, with moderate difficulty

4 = yes, with extreme difficulty

5 = not possible

8. Does the knee pain interfere with sleep?

1 = never

2 = once in a while

3 = some nights

4 = most nights

5 = every night

9. Are you able to work and/or do housework?

1 = yes, with minimal or no problem

2 = yes, most of the time

3 = yes, fairly often

4 = sometimes

5 = rarely or never

10. Does your knee ever feel as though it’s going to give way?

1 = not at all

2 = occasionally

3 = fairly often

4 = most of the time

5 = all the time

11. Are you able to do household shopping?

1 = yes, with minimal or no problem

2 = yes, most of the time

3 = yes, fairly often

4 = sometimes

5 = rarely or never

12. Are you able to walk down a flight of stairs?

1 = yes, with minimal or no problem

2 = yes, most of the time

3 = yes, fairly often

4 = sometimes

5 = rarely or never 

Final Score = ______________ (Add your score from above.)

Results

  • 54 or higher: indicates that your condition is fairly severe
  • 43 to 53: indicates a moderate problem
  • 30 to 42: indicates some problem or inhibited function
  • 18 to 29: indicates that your condition is relatively mild
  • 18 or lower: indicates that you have little to no knee problems