Knee replacement surgery is a big decision. According to a study by the Journal of Orthopaedic Surgery and Research published in April of 2023, the average cost of a knee replacement surgery (with no complications) is $29,300, with prices ranging from $15,000 on the low end and up to $70,000 on the high end. The total cost of this surgical procedure depends on your health insurance plan, where you live, and the health care facility performing the operation.
In most cases, if a health care provider determines that a total or partial knee replacement is medically necessary for you, the operation will be covered by your insurance company. However, it’s important to note that even if your insurance covers the operation, you will likely still incur a co-pay cost. If your coinsurance rate is 19% (the national average) for a $29,300 knee replacement surgical bill (the national average), you may end up paying $23,733 in out-of-pocket costs. If you are uninsured or have a high-deductible plan, you may end up paying even more - if not all - of that price.
Like all health care costs, it’s important that you speak to both the orthopedic surgeon performing the operation and your insurance provider about your insurance coverage so you can make the most informed, financially sound decision about the knee replacement procedure.
What is knee replacement surgery?
Knee replacement surgery (also known as knee arthroplasty) is a medical procedure intended to address pain caused by osteoarthritis. This surgery involves cutting away damaged bone and joint surfaces to restore range of motion to the knee joint and relieve knee pain. An artificial joint replacement (also known as a knee implant) is then fused to the area so the knee can function properly.
Osteoarthritis is the medical term for the normal wear and tear on a joint’s cartilage. Cartilage cushions the ends of bones in a joint, allowing for frictionless movement and shock absorption. After years of use and damage, this cartilage breaks down, and the bones in a joint grind directly on one another. This can limit mobility and cause significant pain. This wear and tear is the most common cause of knee and hip replacement surgeries.
Knee replacement surgery is usually performed in conjunction with other treatment options for knee pain. In addition to the surgery, your health care provider may also recommend physical therapy sessions with a licensed physical therapist to recover mobility and medical equipment such as safety bars to help ease the burden on your joints as you recover.
What factors influence the cost of a knee replacement?
The cost of knee replacement surgery depends on several factors, including your insurance coverage, where you live, the type of surgery you are receiving, and the facility performing the operation.
Insurance: In general, most insurance plans (like Medicare and Medicaid) will cover a portion of knee replacement surgery. How much you pay out-of-pocket depends on your insurance plan’s co-pays, coinsurance, and deductible, as well as whether or not the surgery is deemed medically necessary by a health care provider. For insurance to cover the operation, a doctor must order the surgery - you cannot elect to have it on your own.
Before undergoing knee replacement surgery, talk to your insurance provider about whether or not the procedure is covered by your plan, as well as what additional costs may or may not be covered.
Location: Like most things, health care costs vary depending on where you live. A total knee replacement in New York City, for example, might be priced differently than that same operation in Kansas City. Before you schedule your surgery, it’s recommended that you research the average cost of that procedure in your area. This can help you determine the medical center that’s right for you and your budget. Talk to your insurance provider about what clinics are covered by your plan, and do your research about pricing before you confirm your appointment for knee replacement surgery.
Type of Surgery: Depending on the needs of the patient, a doctor may order a total or partial knee replacement surgery. These procedures come with different costs and recovery needs.
A partial knee replacement surgery involves replacing just one surface of the knee, instead of the entire knee joint. Partial knee replacement surgeries often cost 10-20% less than total knee replacements, as they do not use as much material, or operating room and recovery time. Part of what influences the cost of these surgeries is the amount of time you have to stay in the hospital or surgery center after your operation.
A partial knee replacement generally requires less recovery, so you may save some money on hospital bills. When speaking with your health care provider about knee replacement surgery, feel free to ask whether or not you need a total or partial knee replacement. Some patients may not need the entire knee joint to be replaced. However, if your doctor orders a total knee replacement, this is with your health in mind. While partial knee replacements may be less expensive, they may not be an effective treatment option for severe cartilage damage in the knee.
A total knee replacement, as detailed above, involves completely removing the damaged knee joint and replacing it with an artificial one. This procedure usually requires a greater amount of time spent in the operating room and the surgery center for recovery. This longer stay in a hospital will raise the cost of your medical bills. In addition, because more material is needed to rebuild the knee joint, you will probably have to pay more for this surgery than a partial knee replacement.
Before scheduling a total knee replacement, talk to your health care provider about this treatment option, and whether or not you need a total or partial knee replacement. It is also helpful to talk through recovery methods. While many recovery/ rehabilitation options are covered by insurance, it’s important to get a sense of what will be covered by your insurance and what won’t.
Facility: It is becoming more and more common for knee replacement surgeries to be performed as outpatient procedures - meaning that you do not need a hospital stay overnight. This can save you a considerable amount of money. If you are under 70, in good health, and have a home environment that allows you to recover safely, you can likely undergo a knee replacement surgery as an outpatient procedure.
In some cases, because sedation is used, knee replacement surgeries are performed as inpatient procedures at a hospital. This means that you will likely have to spend a night or two in the hospital before you can go home. This can raise the price of the total cost of your knee surgery.
The total cost of knee replacement surgery will include imaging scans of the joint (like X-rays), the cost of the materials and operation, the anesthesiologist’s fee, and the time spent in the hospital during recovery (if performed as an inpatient procedure). You may also have scheduled follow-up appointments with a health care provider, and recovery tools (such as safety bars and physical therapy) included in this bill.
Before scheduling your operation, talk to your health care provider about whether or not you need a total or partial knee replacement. In addition, it is certainly appropriate to ask whether or not the surgery can be performed as an outpatient - rather than inpatient - procedure. Additionally, it is important that you speak to your insurance provider about what aspects of the procedure are covered by insurance, and what you can expect your out-of-pocket expenses to be. These conversations can help you understand the various charges associated with your medical bills, and will reduce any confusion regarding the costs of the procedure.
What is the recovery like for a knee replacement?
After the surgery, if it has been performed as an outpatient procedure, you will be brought into a recovery room for a few hours as the sedation wears off. You may be given blood thinners or a compression boot to prevent clotting and swelling in the affected joint.
Unless you have to stay at the hospital overnight, you are usually cleared to leave within a few hours of the surgery. It is highly recommended that you have someone pick you up from the hospital and stay with you for the first few days after your surgery so that you can move safely about your house. You may have medical devices (such as a walking aid and safety bars) in your home to help with balance and minimize the impact on the artificial joint as you recover from the surgery.
You will likely also be set up with a physical therapist to help you exercise and strengthen the joint, and restore mobility to your lower body. A licensed PT can guide you through exercises to slowly increase your activity level. They may also recommend some simple exercises you can do by yourself, and wellness measures (like weight management) to help you recover safely and healthfully.
You will likely also have several follow-up appointments with your health care provider so that they can monitor your recovery process and check for any signs of infection or nerve damage in the leg.
In most cases, these recovery methods are covered by your insurance plan. For specifics about what types of recovery are covered, and what are not, talk to your insurance provider about your coverage. This can help you better understand the total cost of your operation bill.
