Knee replacement surgery costs

Knee replacement surgery is a medical operation that helps repair joints by replacing damaged parts with prosthetic components, usually made from metal or plastic.¹ This surgical procedure typically takes around one to two hours and is usually done to help alleviate chronic knee pain.

A knee replacement can potentially:¹

• Reduce knee pain
• Improve flexibility and mobility
• Allow you to be more active.

Knee replacement surgery will usually be used as a last resort when other treatments like medicine and physiotherapy haven’t worked. After surgery, you’ll probably need to spend 1-4 days in hospital. Recovery can take about 12 months, and you will need to undertake an exercise and physiotherapy program.

There are several types of knee replacements depending on the type and severity of your injury. A few of the most common procedures are:

• Total knee replacement surgery.¹ Involves a total replacement of ligaments and joints from the thigh bone (femur) to the connecting part of your shin (tibia).
• Partial knee replacement.² Where your knee might have damaged ligaments that need replacing while conserving others that might still be in good condition.
• Kneecap replacement.³ Unlike total knee replacement surgery, only the kneecap (patella) is replaced with a metal or plastic prosthetic.
• Revision knee replacement (also known as complex knee replacement surgery).⁴ Performed when an existing prosthesis is worn out and needs to be swapped with a new one.

You may consider knee replacement surgery when persistent pain significantly impacts your mobility. It could help alleviate the following ailments:³

• Osteoarthritis. Common among older Australians, osteoarthritis is a condition where cartilage gradually wears down over time.
• Rheumatoid arthritis. An autoimmune disease where the body struggles to fight off infection, resulting in swelling of the joints.
• Haemophilia. A disorder where blood fails to clot. In some cases, the blood that isn’t clotted can fill knee joints and cause damage.
• Skeletal dysplasia. A genetic disorder that affects the development of bone and cartilage.
• Avascular necrosis. When bone tissue dies off from a lack of blood supply.

Most doctors will want to try to manage your knee pain before turning to a knee replacement. Your other treatment options will depend on what’s wrong with your knee and the severity of your pain and discomfort. If you have arthritis, your doctor may want to try the following before suggesting knee surgery:¹

• Physiotherapy
• Medicine
• Weight loss
• Non-impact exercise suitable for your knee condition.

The total cost of knee replacement surgery will depend on the type of surgery you need, the doctors who treat you and whether you’re treated privately or through the public system. Your knee surgery costs may differ from the figures below.

According to the government’s Medical Costs Finder, the typical specialist fee for a total knee replacement as a private patient is $5,200 (based on MBS item number 49518). ⁵ The insurer typically pays $1,800 of this amount while Medicare pays $1,900. However, this is only the amount charged by your doctors (e.g. orthopaedic surgeon and anaesthetist) and does not include any other hospital costs.

The typical hospital fees when admitted to a private hospital for a total knee replacement can add up to around $18,000. ⁵ This can include accommodation, theatre fees, medical devices and more.

However, when you’re covered by an appropriate hospital insurance policy, Medicare together with your health fund will pay 100% of the Medicare Benefits Schedule (MBS) fee – the cost deemed reasonable by the government – for your specialists, while your health fund will also pay some or all of the hospital costs.⁵ Because of this, the average cost paid by patients for a knee replacement in a private hospital is only $1,000 (not including excess or co-payments).

While you may still have some out-of-pocket costs (the difference between your actual specialist fees and the MBS fee), you may be able to avoid them or pay less if you participate in your private health insurance company’s gap cover scheme (if available).

Knee replacement is a major surgery and costs can vary based on factors such as the patient’s other health conditions and the complexity of the surgery. For more details about your surgery and any out-of-pocket expenses, you should have a discussion with your surgeon and your health fund before the operation. They’ll know the specifics of your surgery and will be able to offer a more accurate quote.

Knee replacements fall under the ‘joint replacement’ clinical category, so your policy will need to have this inclusion for you to receive benefits. Gold hospital policies cover knee and other joint replacement surgeries. However, depending on the health fund, joint replacement surgeries may also be included in Silver ‘plus’ policies. This is why it’s important to shop around.

You’ll likely need to undertake physiotherapy as part of your recovery process. Physiotherapy is a common inclusion with extras cover. You might want to consider combined cover to help with your entire treatment and recovery process.

If you don’t have an eligible hospital cover, Medicare will cover the entire costs of your total knee replacement as a public patient in a public hospital. However, you won’t be able to choose your doctor, hospital or time of surgery.

Knee replacements are generally considered elective surgery, which means you’d have to go on a waiting list if you sought treatment through the public healthcare system. According to the Australian Institute of Health and Welfare (AIHW), around half of the people on the waiting list for a total knee replacement waited 265 days for their surgery in 2023-24, while 25.7% waited more than a year. ⁶

So, if you’re looking to avoid the public waiting list and get back to healthy living faster, you might consider taking out an appropriate level of hospital cover.