Hip Functionality and Pain Survey

How do I know if I need hip surgery?

Chronic hip pain can gradually transition from being manageable to necessitating surgery, often without you recognising the severity of the change.

Are you a candidate for a total hip replacement?

The following survey consists of twelve questions designed to assess the severity of your hip pain and the functionality of your hip. This self-assessment tool can help monitor the degree of pain and indicate possible treatment options. You will need to provide your information so that we can send you your results.

If your hip is swollen, infected, or causing you severe pain, make sure to see a doctor right away.

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1. How severe would you describe your typical hip pain?*
2. Have you had any sudden, severe pain from your affected hip?*
3. Does your hip pain cause you to limp when walking?*
4. How difficult is it to perform your daily activities (work, housework, etc.) because of your hip pain?*
5. How difficult is it to get dressed (specifically putting on socks, stocking, or tights) because of your hip pain?*
6. How long can you walk before your hip pain starts to appear, either with or without a walking stick?*
7. How difficult/painful is it in your hip to stand up after sitting for some time?*
8. How difficult is it to get in and out of the car or use public transport, either with or without a walking stick, because of your hip pain?*
9. How difficult is it to go shopping on your own?*
10. How difficult is it to walk up or down a flight of stairs?*
11. How difficult is it to wash and dry yourself because of your hip pain?*
12. How severe is your pain when laying in bed at night?*

Patient Details

Your results will be emailed and you will be contacted by the Ortho Precision team if we feel you are a strong candidate for our hip pain treatment services.

Name*
Have you previously had a joint replacement?
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