How much does a knee replacement cost?

Knee replacement surgery can get you moving again, but will it break the bank? Here’s how much it might cost and how private health insurance for a knee replacement works.

Knee replacement is surprisingly common in Australia, with industry data showing over 62,000 knee replacements were undertaken in 2020 – and that was a year when COVID meant fewer surgeries were performed than normal. In fact, Australia has one of the highest rates of knee replacement in the world.

While a knee replacement may be required as a result of a sporting accident, the majority of knee replacements are performed on people aged over 60, according to Healthdirect, with osteoarthritis being a common driver of knee replacement surgery. The procedure has the potential to be a game changer, as it could help to relieve pain and increase mobility, according to St Vincent’s Private Hospitals.

Many people considering knee replacement surgery may be concerned about the possible hip pocket pain of the cost involved. We take a look at knee replacement costs, with tips on opportunities to minimise the expense.

What is a knee replacement?

Knee replacement surgery, also known as total knee arthroplasty or total knee replacement, is a medical procedure in which parts of the knee joint are operated on and cut back to remove any diseased or damaged tissue. According to the government’s health advice service, Healthdirect, the removed joint parts are then replaced with metal and plastic prostheses that mimic the natural function of a knee.

How much does a knee replacement cost?

There are generally two ways to have knee replacement surgery performed – via the public system, which is covered by Medicare, or in a private hospital, where some or all of the costs are covered by health insurance with hospital cover. There is also the option of funding the full cost of the surgery in a private hospital, without health insurance.

Public health system knee replacement:

If you don’t have private health insurance, a knee replacement can potentially cost next to nothing. If you’re happy to have knee replacement surgery performed as a public patient in a public hospital, you could face little or no out of pocket expenses.

The drawback is that you could be placed on the end of a long waiting list for surgery. The latest data from the Australian Health and Welfare Institute shows that in 2021/22, 12.8% of public patients waited more than a year for orthopaedic surgery. That can be a long time if you’re living with chronic pain and mobility loss.

Also, you will not be able to choose your medical specialists.

Private health insurance knee replacement:

If you have private health insurance, it may be possible to fast-track your knee replacement surgery. You may also be able to choose your own specialist.

As a private patient, however, you could face out of pocket costs. How much you’re likely to pay depends on:

• the type of knee replacement surgery
• the excess under your health insurance policy
• the hospital you’re admitted to
•  your choice of doctor.
• You could also face additional costs for your anaesthetist.

Before you commit to any procedures, it’s a good idea to ask for a written quote that details your out-of-pocket costs.

As a guide of what you could expect to pay, the table below shows a range of knee replacement procedures and the associated out of pocket costs based on the Medicare Benefits Schedule (MBS) – a list of health professional services that the Australian Government subsidises. The balance remaining after the 75% Medicare rebate represents a general estimate of the likely out-of-pocket costs for knee replacement surgery, however keep in mind that this could vary.

In case you’re wondering about what ‘revision of total or partial replacement of knee’ means, Sydney Knee Specialists say all forms of knee replacement surgery have a finite lifespan. So, if your original knee replacement starts to work less effectively, you may at some stage need a ‘revision knee replacement operation’.

Medicare Benefits Schedule (MBS) knee surgery costs vs Medicare rebate

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Source: MBS

Private hospital, without health insurance (self-funded) knee replacement:

According to health insurer BUPA, the average cost of knee replacement surgery is around $27,000, while Queensland Knee Surgery Clinic puts it at around $25,000. This would vary according to the specialist, location, type of surgery and other factors.

Medicare may cover some of the costs, for example, specialist fees where a MBS item number applies. However, according to PrivateHealth.com.au, it does not cover private patient hospital costs, for example, theatre fees or accommodation. If you choose to self-fund a knee replacement, it could be a wise idea to obtain written quotes from your treating doctors and allied health professionals, as well as from the private hospital.

Wait times for knee replacement surgery

As discussed previously, if you are a public patient in a public hospital, and you need a knee replacement, you will be placed on a waiting list.

If you are a private patient with private health insurance, attending a private hospital, you can typically schedule your surgery according to the specialist’s availability and your convenience.

If you have private health cover you will likely need to serve out wait times before you can make a claim for knee replacement surgery. This can be as little as two months or up to 12 months if problems with your knee relate to a pre-existing condition, depending on the rules of the insurer.

How to save on knee replacement costs

A few steps could help you reduce the cost of knee replacement surgery:

Know what’s offered by your level of cover

If you’re relying on private health cover to pay for knee replacement surgery costs, PrivateHealth.com.au states that you’ll need to find a level of cover that includes ‘joint replacement’. You can use Canstar’s comparison tool to compare hospital (or hospital and extras) policies that include this cover. The highest level of cover, Gold, generally includes this category of cover. Health insurance providers can also choose to add joint replacements to Bronze and Silver hospital policies, but it is optional, and the additional coverage is called a ‘Plus’ policy.

Ask your surgeon about out-of-pocket costs

Research by Medibank found there can be significant differences in the out-of-pocket costs charged by different surgeons. This can make it worth talking to your GP, and orthopaedic surgeon about the likely knee replacement costs. You may be able to partner with a specialist who charges a lower out-of-pocket cost.

Shop around and compare health fund providers

A report from the Australian Medical Association (AMA) found some health insurers can be more generous than others when it comes to the rebates paid for knee replacement surgery.

As the table below shows, you could pay up to 26% less for a knee replacement surgery depending on your choice of fund. This difference highlights the value of shopping around between health insurance providers.

Benefits paid for knee replacement by different private health insurers (as at 15 October 2022)

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Source: AMA Private Health Insurance Report Card 2022. Costs don’t take into account other expenses such as anaesthetics

Will I need rehab following knee replacement surgery?

According to HCF, you may be encouraged to stand in as little as 24 hours of knee replacement surgery to get the surrounding structures working as quickly as possible. From here, a physiotherapist may visit you in hospital to explain various knee exercises you can do.

After you leave the hospital, you may choose to continue with regular physiotherapy to help you knee recover. Healthdirect suggests that exercise and physiotherapy can help you recover sooner. The cost of physiotherapy can typically be claimed through extras cover.

If all goes well, Healthdirect says your knee strength and flexibility should return after about 12 months.

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