Knee replacement surgery
What is knee replacement?1
Knee replacement is a type of surgery in which a damaged knee joint is replaced with an artificial one. The surgery is generally considered to be safe and effective. For most patients it results in less pain and more ability to be active.
The most common reason for a knee replacement is to treat osteoarthritis of the knee. Most people who have a knee replacement are over 60 years of age, and knee replacement is usually recommended to treat severe pain or disability.
The medical term for knee replacement is knee arthroplasty
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Public and private hospital options
It’s important to understand how getting your procedure in a public or private hospital differs.
| Question | Public system (Without health insurance) | Private system (With health insurance) |
|---|---|---|
| Will I avoid public hospital waiting lists? |
No. |
Yes. |
| Will I be able to choose my hospital? |
No. |
Yes. |
| Will I be able to choose my doctor or surgeon? |
No. |
Yes. |
| Will I have out-of-pocket costs? |
No. |
Yes. |
What’s covered in a public hospital?
In a public hospital, knee replacement surgery is covered by Medicare for eligible residents.
Once you are discharged from hospital, you may still need to pay out-of-pocket for things like medicines and physiotherapy.
What’s covered in a private hospital?
In a private hospital, private health insurance can cover some costs of knee replacement surgery. You may have an out-of-pocket cost if you use private hospital cover when you get treatment.
You can minimise some of these costs by choosing a hospital and specialist that have agreements with your health insurer.
If you have an excess on your cover, you will have to pay for that out of pocket.
What is hospital excess?
Hospital excess is the amount of money you contribute upfront (out of your own pocket) before you can claim a benefit on hospital treatment. With HBF hospital cover, you choose a set excess option when you first get hospital cover, but you can change your excess at any time.
With HBF, you only pay hospital excess once per person, per calendar year (to a maximum of twice on a family policy) when you’re admitted to hospital.
Are you an HBF member? You can check your excess in myHBF or the HBF App. This is the set amount you’ll pay when you’re admitted.
What is an out-of-pocket cost?
A hospital out-of-pocket cost is the portion of a hospital bill that you pay from your own pocket for which you won’t be reimbursed – by either health insurance or Medicare.
How to find health cover for knee replacement surgery
If you want private health insurance cover for knee replacement surgery, look for HBF hospital cover (not extras cover) that includes a category called ‘Joint replacements’.
You need to hold hospital cover that includes Joint replacements for two months before you can claim for knee replacement surgery (or 12 months if you need knee replacement surgery due to a pre-existing condition such as osteoarthritis).
Ask your GP for an open referral
Your GP is the one who’ll most likely refer you to a specialist – but they may not recommend the specialist you’d want to perform your surgery. Asking for an open referral can let you:
- Choose your own specialist.
- Find a specialist with good availability who can perform treatment at the hospital you prefer.
- Find a specialist that you trust to perform your surgery.
- Find a specialist with minimum out-of-pocket expenses for you.
Find an orthopaedic surgeon with minimum out-of-pocket costs
To find orthopaedic surgeons who work with HBF, just search for ‘orthopaedic surgeon’ in our find a provider tool.
- Look for the “Full Cover” tick mark or “Access Gap Cover” tick mark.
- These specialists will help minimise your out-of-pocket cost.
If you’ve already started working with a specialist
If you’ve already got a specialist, ask them these questions:
- Do you have a Full Cover or No Gap agreement with HBF?
If they don’t, you may need to consider if their fees work with your budget. - What hospital(s) do you operate in?
You can then check if the hospital has a Full Cover or No Gap agreement with HBF.
Signs you might need knee replacement2
Knee replacements are usually only considered if lifestyle changes, medicines and other treatments like physiotherapy are not helping.
Here are some signs that your knee needs some kind of treatment:
- Severe knee pain or stiffness that makes it hard to walk, climb stairs or get in and out of chairs.
- Moderate or severe knee pain while resting.
- Knee pain that doesn’t improve with rest or medications.
- Knee pain that interferes with sleep or general daily activities.
Alternatives to knee replacement2
- Non-impact exercise.
- Losing weight.
- Physiotherapy.
- Medicines.
- Knee injections.
Knee replacement recovery1
Most patients leave hospital one to four days after knee replacement surgery.
- For a few weeks following surgery, crutches, a cane or a walking frame are usually needed.
- Typically, joint strength and flexibility gradually recovers over a 12-month period.
- Seeing a physiotherapist and doing the recommended rehabilitation exercises can help speed up recovery.
Private health insurance can help with physiotherapy costs too, if you get extras cover that includes physiotherapy.
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Further reading
