| www.surabayakneecenter.com |
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Threshold for knee replacement |
| Surabaya Knee Score |
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Clinician’s name (or ref)
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Patient’s name (or ref)
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| Please answer the following 12 multiple choice questions. |
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| During the past 4 weeks…… |
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Nb: This page cannot be saved due to patient data protection so please print the filled in form before closing the window.
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The Surabaya Knee Score is:
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Grading for the Surabaya Knee Score
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| Score 0 to 19 |
May indicate severe knee arthritis. It is highly likely that you may well require some form of surgical intervention, contact your family physician for a consult with an Orthopaedic Surgeon.
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| Score 20 to 29 |
May indicate moderate to severe knee arthritis. See your family physician for an assessment and x-ray. Consider a consult with an Orthopaedic Surgeon.
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| Score 30 to 39 |
May indicate mild to moderate knee arthritis. Consider seeing your family physician for an assessment and possible x-ray. You may benefit from non-surgical treatment, such as exercise, weight loss, and /or anti-inflammatory medication
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| Score 40 to 48 |
May indicate satisfactory joint function. May not require any formal treatment.
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Reference for Score: Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement.
J Bone Joint Surg Br. 1998 Jan;80(1):63-9. Link
Reference for Grading: Link
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