Painful Knee Replacement Survey - Atlanta Bone and Joint Specialists

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Painful Knee Replacement Survey

Painful Total Knee Questionnaire

* Indicates required field

What is your age? *

Under 18 18-50 50-60 60-70 70-80 Over 80

When Was Your Knee Replacement Done *

Within 1 year 1-2 years ago 3-5 years ago 6-10 years ago 10-20 years ago 20+ years ago

Who did your joint replacement? *

What hospital was your surgery performed at? *

Which symptoms do you feel? *

Pain that never goes away Pain at night Pain during the day occasionally Pain with every step Feeling of knee giving out Pain under the knee cap Pain going up and down stairs Crunching noises Popping noises Inability to straighten all the way Inability to bend all the way

Does your knee get fully straight *

Yes No I am not sure

Have you been worked up for an infection? *

Yes No I don't know

Name *

First

Last

Email *

Phone Number *

Submit

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Office Hours / Horario

Monday–Friday: 9:00 AM–5:00 PM
Lunes–Viernes: 9:00 AM–5:00 PM

Saturday Football Clinic

Saturdays during high school football season
Sábados durante la temporada de fútbol americano escolar

Injured Players Only / Solo jugadores lesionados

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