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Knee Injury & Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR)

7-item knee survey to evaluate outcomes after total knee arthroplasty; scoring pain, stiffness and function.

CreatorDr. Stephen Lyman, PhD
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Instructions

  • This  survey  asks  for  your  opinion  about  your  knee  and  helps  us  understand  how  well  you  are  able   to  complete  your  usual  activities.  

  • Answer  each  question  by  selecting  the  appropriate  box  (only  one box  for  each  question).  If  you  are  uncertain  about  how  to  answer  a  question,  please  give  the  best   answer  you  can.

The KOOS JR (Knee injury and Osteoarthritis Outcome Score for Joint Replacement) is a seven-question survey that measures knee health in patients with knee osteoarthritis, especially before and after total knee replacement. Stephen Lyman, PhD, and colleagues (2016) at Hospital for Special Surgery (HHS) picked the seven most relevant questions from the original 42-question KOOS, created by Ewa Roos, PhD, and colleagues (1998). It combines pain, stiffness, and daily function into one score, so patients can finish it in a few minutes and clinicians can track progress easily. CMS uses it in its required patient-reported outcome measure for elective knee replacement.

What it asks: Patients rate their knee over the past week on seven items. One is about morning stiffness. Four are about pain: twisting or pivoting, straightening the knee fully, going up or down stairs, and standing upright. Two are about daily function: rising from sitting, and bending to the floor to pick something up. Each item uses the same five answers: None (0), Mild (1), Moderate (2), Severe (3), or Extreme (4).

How it’s scored: Scoring has two steps. First, add the seven answers to get a raw score from 0 to 28, where higher means worse. Second, convert that raw score to an interval score from 0 to 100 using HSS’s published conversion table. On the final scale the direction flips: 100 means perfect knee health and 0 means total knee disability. For example, a raw score of 14 converts to 52, and a raw score of 7 converts to 68. The table isn’t a straight line, so you can’t get the result by simple division, and that’s where hand scoring often goes wrong.

Conversion Table

Raw Score

Interval Score

Raw Score

Interval Score

Raw Score

Interval Score

0

100.000

10

61.583

20

36.931

1

91.975

11

59.381

21

34.174

2

84.600

12

57.140

22

31.307

3

79.914

13

54.840

23

28.251

4

76.332

14

52.465

24

24.875

5

73.342

15

50.012

25

20.941

6

70.704

16

47.487

26

15.939

7

68.284

17

44.905

27

8.291

8

65.994

18

42.281

28

0.000

9

63.776

19

39.625

How results are used: The KOOS JR is usually given before surgery to set a baseline and again after recovery. The difference between the two interval scores shows how much the patient improved. For CMS reporting, an improvement of at least 20 points counts as a substantial clinical benefit.

©  Hospital  for  Special  Surgery.  The  tools  listed  on  this  website  do  not  substitute  for  the  informed  opinion  of  a  licensed   physician  or  other  health  care  provider.  All  scores  should  be  re-­‐checked.  Please  see  our  full  Terms  of  Use.

All questions & possible results

Affected KneeTitle not visible
Affected Knee

Select one option:

  • Right
  • Left
  • Both
Stiffness

  • The following question concerns the amount of joint stiffness you have experienced during the last week in your knee.

  • Stiffness is a sensation of restriction or slowness in the ease with which you move your knee joint.

1. How severe is your knee stiffness after first wakening in the morning?

Select one option:

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme
Pain

What amount of knee pain have you experienced the last week during the following activities?

2. Twisting/pivoting on your knee

Select one option:

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme
3. Straightening knee fully

Select one option:

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme
4. Going up or down stairs

Select one option:

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme
5. Standing upright

Select one option:

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme
Function, Daily Living

  • The following questions concern your physical function. By this we mean your ability to move around and to look after yourself.

  • For each of the following activities please indicate the degree of difficulty you have experienced in the last week due to your knee.

Rising from sitting

Select one option:

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme
Bending to floor/picking up an object

Select one option:

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme
Possible results
Pertinent Positive: Extreme knee pain with twisting/pivoting on knee
Pertinent Positive: Extreme knee pain with Straightening knee fully
Pertinent Positive: Extreme knee pain with going up or down stairs
Pertinent Positive: Extreme knee pain with standing upright
Pertinent Positive: Extreme knee pain with rising from sitting
Pertinent Positive: Extreme knee pain with bending to floor/pick up an object
Pertinent Positive: Severe knee stiffness after first awakening in morning
Pertinent Positive: Severe knee pain with twisting/pivoting on knee
Pertinent Positive: Severe knee pain with Straightening knee fully
Pertinent Positive: Severe knee pain with going up or down stairs
Pertinent Positive: Severe knee pain with standing upright
Pertinent Positive: Severe knee pain with rising from sitting
Pertinent Positive: Severe knee pain with bending to floor/pick up an object
Pertinent Positive: Moderate knee stiffness after first awakening in morning
Pertinent Positive: Moderate knee pain with twisting/pivoting on knee
Pertinent Positive: Moderate knee pain with Straightening knee fully
Pertinent Positive: Moderate knee pain with going up or down stairs
Pertinent Positive: Moderate knee pain with standing upright
Pertinent Positive: Moderate knee pain with rising from sitting
Pertinent Positive: Moderate knee pain with bending to floor/pick up an object
Pertinent Positive: Mild knee stiffness after first awakening in morning
Pertinent Positive: Mild knee pain with twisting/pivoting on knee
Pertinent Positive: Mild knee pain with Straightening knee fully
Pertinent Positive: Mild knee pain with going up or down stairs
Pertinent Positive: Mild knee pain with standing upright
Pertinent Positive: Mild knee pain with rising from sitting
Pertinent Positive: Mild knee pain with bending to floor/pick up an object
Pertinent Negative: No knee stiffness after first awakening in morning
Pertinent Negative: No knee pain with twisting/pivoting on knee
Pertinent Negative: No knee pain with Straightening knee fully
Pertinent Negative: No knee pain with going up or down stairs
Pertinent Negative: No knee pain with standing upright
Pertinent Negative: No knee pain with rising from sitting
Pertinent Negative: No knee pain with bending to floor/pick up an object
KOOS, JR. Interval Score

Scoring

  • A Higher score represents better function.

  • The raw summed score is converted to an interval score from 0 to 100, where 0 represents total knee disability and 100 represents perfect knee health.

Interpretation

  • The KOOS, JR. interval score summarises knee pain, stiffness and functional limitation in a single number from 0 to 100. A higher score means less knee difficulty; a lower score means more. The score is interpreted by your clinician, usually by comparing it with your earlier scores to track change over time.

KOOS, JR. Raw Score

  • A lower score represents better function.

  • The sum of the seven item responses, from 0 (no symptoms) to 28 (extreme symptoms).

  • The interval score above converts this raw total to a 0–100 scale.

Pertinent Positive: Extreme knee stiffness after first awakening in morning

Citation

The KOOS, JR is copyrighted by Hospital for Special Surgery. Items derived from the KOOS (Roos EM). Validation: Lyman S, et al. Clin Orthop Relat Res. 2016;474(6):1461–1471. This tool does not replace the judgment of a licensed health care provider.

Literature

  • Lyman, Stephen, et al. “Validation of the KOOS, JR: a short-form knee arthroplasty outcomes survey.” Clinical Orthopaedics and Related Research® 474.6 (2016): 1461-1471.

    https://pubmed.ncbi.nlm.nih.gov/26926773/

  • Hung, Man, et al. “Evaluating instrument responsiveness in joint function: The HOOS JR, the KOOS JR, and the PROMIS PF CAT.” Journal of Orthopaedic Research (2017).

    https://pubmed.ncbi.nlm.nih.gov/28921658/

  • Lyman, Stephen, and Chisa Hidaka. “Patient-Reported Outcome Measures—What Data Do We Really Need?.” The Journal of arthroplasty 31.6 (2016): 1144-1147.

    https://pubmed.ncbi.nlm.nih.gov/27157278/

  • Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998 Aug;28(2):88-96.

    https://pubmed.ncbi.nlm.nih.gov/9699158/

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