Do you need Total Knee Replacement Surgery?

2. Could you kneel down and get up again afterwards?

Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible

3. Have you had any trouble washing and drying yourself (all over) because of your knee?

No trouble at all
Very little trouble
Moderate trouble
Extreme difficulty
Impossible to do

4. Are you troubled by pain in your knee at night in bed?

Not at all
Only one or two nights
Some nights
Most nights
Every night

5. Have you had any trouble getting in and out of the car or using public transport because of your knee? (With or without a stick)

No trouble at all
Very little trouble
Moderate trouble
Extreme difficulty
Impossible to do

6. How much has pain from your knee interfered with your usual work? (including housework)

Not at all
A little bit
Moderately
Greatly
Totally

7. For how long are you able to walk before the pain in your knee becomes s eve re? (With or without a stick)

No pain > 60 min
16 - 60 minutes
5 - 15 minutes
Around the house only
Not at all - severe on walking

8. Have you felt that your knee might suddenly (give away) or let you down?

Rarely / Never
Sometimes or just at first
Often, not at first
Most of the time
All the time

9. After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your knee?

Not at all painful
Slightly painful
Moderately pain
Very painful
Unbearable

10. Could you do household shopping on your own?

Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible

11. Have you been limping when walking, because of your knee?

Rarely / Never
Sometimes or just at first
Often, not at first
Most of the time
All the time

12. Could you walk down a flight of stairs?

Yes, easily
With little difficulty
With moderate difficulty
With extreme difficulty
No, impossible