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 another 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 min

2= 16-30 minutes

3= 5-15 minutes

4= Less than five 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

6. Do you limp because of your knee and, if so, what is the severity of the limp?

1= Not at all

2= Sometimes or only at first

3= Often

4= Most of the time

5= Constantly 

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= Not at all

2= Occasionally

3= Fairly often

4= Most of the time

5= All the time

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.