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  • Research Questionnaire

    Knee replacement

    Thank you for filling out this questionnaire which Dr Pai uses to ensure you are recovering well from your surgery. To keep track of your progress, you will be asked to complete this again at your future follow-up appointments. This questionnaire should take no longer than 10 minutes.

    All the questions pertain to the side you have had surgery on. If you have any questions, please don't hesitate to ask our practice team at admin@vishalpai.com or call us on 03 8657 0595.

  • Date of Birth*
     - -
    2 digit day, 2 digit month, 4 digit year
  • At what time point are you filling this form?*

  • Satisfaction Rating

  • How satisfied are you with the results of your surgery?
  • Would you undergo this surgery again?

  • EQ-5D-5L

  • Under each heading, please tick the ONE box that best describes your health TODAY:

  • MOBILITY*
  • SELF-CARE*
  • USUAL ACTIVITIES (e.g. work, study, housework, family or leisure activities)*
  • PAIN / DISCOMFORT*
  • ANXIETY / DEPRESSION*

  • We would like to know how good or bad your health is TODAY.

    This scale is numbered from 0 to 100.

    100 means the best health you can imagine.

    0 means the worst health you can imagine.

  • Please adjust the scale to indicate how your health is TODAY.*

  • Oxford Knee Score

  • Q1. How would you describe the pain you usually have from your knee?*
  • Q2. Have you had any trouble with washing and drying yourself (all over) because of your knee?*
  • Q3. Have you had any trouble getting in and out of a car or using public transport because of your knee? (whichever you tend to use)*
  • Q4. For how long have you been able to walk before the pain from your knee becomes severe (with or without a stick)?*
  • Q5. After a meal (sat at a table), how painful has it been for you to stand up from a chair because of your knee?*
  • Q6. Have you been limping when walking, because of your knee?*
  • Q7. Could you kneel down and get up again afterwards?*
  • Q8. Have you been troubled by pain from your knee in bed at night?*
  • Q9. How much has pain from your knee interfered with your usual work (including housework)?*
  • Q10. Have you felt that your knee might suddenly “give way” or let you down?*
  • Q11. Could you do the household shopping on your own?*
  • Q12. Could you walk down a flight of stairs?*

  • Forgotten Joint Score

  • The following 12 questions refer to how aware you are of your knee joint in everyday life. Please select one answer from each question.

    Are you aware of your joint…

  • Should be Empty: