Date of completion
Knee Society Score - Function    
Clinician's name (or ref) Patient's name (or ref)
Please answer the following questions.  
Part 2 - Function
>10 blocks
5-10 blocks
<5 blocks


Normal Up and down
Normal Up down with rail
Up and down with rail
Up with rail, down unable


Walking aids used
None used
Use of Cane/Walking stick deduct
Two Canes/sticks
Crutches or frame
Function Score (Knee Society Score) is (NB: consider a negative outcome as zero)

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Reference for score: Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989 Nov;(248):13-4. link to pubmed

Reference for Grading: Asif S , Choon DS . Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg (Hong Kong). 2005 Dec;13(3):280-4.