Knee replacement in Australia: cost, wait times and the cover you need

How much does a knee replacement cost in Australia in 2026–27?

A total knee replacement in Australia costs between nothing and roughly A$23,200, depending on how you are treated. The table sets the three routes side by side with the wait that comes with each. Figures are national and dated in each row.

Sources: AIHW MyHospitals ES 2024-25; Medical Costs Finder, knee replacement, 2023–24 data. Last verified 8 November 2026.

The insured figure is only the doctors’ gap. The Medical Costs Finder counts the surgeon, assistant surgeon and anaesthetist together, and leaves out the excess, hospital charges not covered, aftercare and tests. Among insured patients who paid a gap in 2023–24, the low figure was A$250 and the high figure A$4,800 (Medical Costs Finder, read 8 November 2026).

The uninsured total is a rough guide, not a quote. The two medians come from different groups of patients and do not have to add up. Medicare still pays 75% of the MBS fee for each doctor’s item for a private patient without insurance, which brings the A$5,200 down. How the doctors’ gap is worked out is covered in our guide to gap fees and out-of-pocket costs.

This page gives general information about costs, waits and cover in Australia in 2026–27. It is not medical advice and not personal financial advice. Whether and when to have a knee replacement is a decision for you and your treating doctor.

How long is the public waiting list for a knee replacement in Australia?

Half of public patients in Australia waited 255 days or more for a total knee replacement in 2024–25. That was 10 days shorter than the 265-day median in 2023–24 and 53 days shorter than the 308 days of 2020–21, according to the Australian Institute of Health and Welfare (AIHW).

Source: AIHW MyHospitals datasets ES 2020-21, ES 2023-24 and ES 2024-25, total knee replacement, national (data uploaded 2 November 2026). Last verified 8 November 2026.

The year hides a rise at the end of it. The AIHW’s quarterly medians for total knee replacement were 247 days in the September 2024 quarter, 234 in December 2024, 251 in March 2025 and 281 in June 2025. A year earlier the same four quarters were 283, 259, 244 and 264 days (AIHW elective surgery dashboard, last updated 25 November 2025).

Waits also differ by patient. In 2024–25, half of First Nations patients were admitted within 294 days and half of other Australians within 242 days, the largest gap of any procedure the AIHW reports (page last updated 21 July 2026). Across orthopaedic surgery, 11% of public patients waited more than a year.

The AIHW counts the wait from the day the surgeon lists you as ready, not from the GP referral. Time waiting for a first public specialist appointment is extra. The AIHW’s 90th percentile for knees sits in a visualisation that returned a server error on 8 November 2026, so it is not quoted here.

Which state has the longest wait for a knee replacement?

The Australian Capital Territory had the longest public wait for a total knee replacement in 2024–25, with a median of 388 days, and 53.0% of its patients waited more than a year. New South Wales was next at 340 days. Victoria was shortest at 133 days.

Source: AIHW MyHospitals, ES 2024-25 and ES 2023-24, total knee replacement, by state. “Not published” means the AIHW withheld the figure because too few patients met its reporting rules. Last verified 8 November 2026.

New South Wales was the only state with figures in both years whose median got longer, by 19 days. Tasmania shortened by 48 days and Victoria by 48. New South Wales also did 40% of all public knee replacements in Australia in 2024–25: 7,172 of 17,987, by Plain Cover’s arithmetic. Shorter waits did not always mean more operations. Victoria admitted 3,839 knee replacement patients from its lists in 2024–25, down from 4,556 in 2023–24, and Tasmania 559, down from 700. The ACT admitted 202, up from 55. Hospital-level waits are on the AIHW’s MyHospitals site, and the gap between two hospitals in one city can be larger than the gap between states. How the public list works for any operation is in our guide to public vs private hospital care.

How much does a knee replacement cost in each state with private cover?

With hospital cover in Australia, the out-of-pocket cost of a knee replacement depends heavily on where you live. In 2023–24, insured patients in the ACT who paid a gap typically paid A$4,500. In South Australia and Tasmania it was A$500. Western Australia had the most patients paying nothing, 46%.

Source: Medical Costs Finder, knee replacement (MBS item 49518), private patients with insurance, 2023–24 data. Typical values are medians and include the surgeon, assistant and anaesthetist. Last verified 8 November 2026.

Two patterns stand out. The ACT has both the longest public wait and the largest private gap, so neither route is cheap or quick there. New South Wales pairs a 340-day public median with a A$2,500 typical gap. In Western Australia nearly half of insured patients paid nothing for their doctors, which suggests many surgeons there billed within insurers’ no gap limits.

These are the doctors’ fees only. The policy excess applies on top, and the Medical Costs Finder notes that hospital charges, typically A$18,000 nationally, may be covered “all or part” by insurance (read 8 November 2026).

Which hospital cover pays for a knee replacement?

Gold is the only hospital tier in Australia that must cover a knee replacement. Joint replacements is a clinical category, and PrivateHealth.gov.au lists it as a minimum requirement for Gold and optional for Basic, Bronze and Silver (product tiers page, read 8 November 2026). An insurer may add it to a lower tier and sell the policy as Bronze Plus or Silver Plus.

Source: PrivateHealth.gov.au product tiers table, read 8 November 2026.

The category is broader than a total knee. PrivateHealth.gov.au describes joint replacements as surgery “including revisions, resurfacing, partial replacements”, and lists MBS item 49518, total arthroplasty of the knee, under it. Joint fusions sit in bone, joint and muscle instead.

The policy document that settles it is the Private Health Information Statement. For a knee replacement, joint replacements has to appear as covered, not restricted and not excluded. PrivateHealth.gov.au explains that a restricted benefit only partly covers hospital costs, at about the level of a private patient in a public hospital, so a private hospital or private room can leave significant costs. Our guide to Silver Plus and Bronze Plus policies shows how much the “Plus” extras differ between insurers, and the full list of clinical categories shows every category by tier.

Why a Silver policy can leave you paying for the whole knee replacement

A Silver hospital policy in Australia must cover 29 clinical categories, and joint replacements is not one of them. Silver does include “bone, joint and muscle” and “joint reconstructions”, and that is where the misreading starts. PrivateHealth.gov.au lists knee replacements under a separate category, joint replacements, which Silver insurers may leave out (read 8 November 2026).

If the category is excluded, the insurer pays nothing toward the hospital, the theatre or the artificial knee for that admission. A private knee replacement is then paid as if uninsured: about A$23,200 on the Medical Costs Finder’s 2023–24 typical figures, less Medicare’s 75% of each doctor’s MBS fee. The other option is the public list.

Two more gaps catch knee replacement patients on Basic, Bronze and Silver policies:

• Rehabilitation can be restricted. PrivateHealth.gov.au marks rehabilitation as “restricted cover permitted” for Basic, Bronze and Silver, but not Gold. Inpatient rehab after the operation may then be paid only at public hospital rates.
• Upgrading after the knee starts hurting. Moving from Silver to Gold adds joint replacements as new cover. The 12-month pre-existing wait applies to that category, while the Silver categories keep their served time.

PrivateHealth.gov.au says the upgrade rule runs from the date you upgrade, so the 6-month symptom window is counted back from that day. How the insurer’s doctor decides is in our guide to pre-existing conditions.

What does Medicare pay toward a knee replacement in 2026–27?

For a private patient in Australia, Medicare pays 75% of the MBS fee for each doctor’s item, and the health insurer pays at least the other 25% if the policy covers joint replacements. MBS Online lists a fee for every item a knee replacement team bills. The table converts each fee into dollars, from 1 July 2026.

Source: MBS Online, items as listed, schedule fees updated 1 July 2026. Item 51303 fee and benefit are Plain Cover calculations from the item’s one-fifth rule. Last verified 8 November 2026.

For one total knee, the surgeon, assistant and anaesthetic start items add up to A$2,058.66 in MBS fees. Medicare pays A$1,544.05 and the insurer at least A$514.61. The anaesthetist also bills time on further MBS items, so the anaesthetic fee is larger than item 21402 alone. MBS Online also flags items 49518 and 49517 under the multiple operation rule, which lowers the fee for any extra procedure done in the same operation. Items 49518, 49517 and 21402 carry the “(H)” mark, used for services to a patient admitted to hospital, which is when private hospital cover can pay its share.

The Medical Costs Finder puts typical specialists’ fees for a knee replacement at A$5,200 in 2023–24, about 2.5 times the A$2,058.66 schedule, by Plain Cover’s arithmetic. The difference is what no gap and known gap arrangements are there to cover, as our gap fees guide explains.

Does private health insurance pay for the artificial knee?

Yes, if the knee implant is on the Prescribed List and the policy covers joint replacements. The Department of Health, Disability and Ageing says insurers must pay a benefit for a listed device when a Medicare benefit is payable for the operation, the device is implanted during hospital treatment, and you have appropriate cover (page last updated 13 March 2025, read 8 November 2026).

The Prescribed List of Medical Devices and Human Tissue Products has more than 11,000 items, and hip, knee and shoulder joint replacement devices are the first example the Department gives. It sets the minimum benefit insurers must pay for each. The Department states that with appropriate cover you “should not have any out of pocket costs” for a listed device. If the minimum benefit is lower than the price of the product, you may pay the difference. The Department suggests discussing the cost with the insurer, the treating doctor and the hospital beforehand.

Device benefits are a large and growing part of what Australian insurers pay out:

Source: APRA Quarterly Private Health Insurance Statistics, June 2025 edition (27 August 2025) and June 2026 edition (27 August 2026). Last verified 8 November 2026.

APRA does not split device benefits by operation, so the knee share is not published. The Medical Costs Finder’s typical A$18,000 hospital fee for a knee replacement includes “medical device fees”.

Worked example: the 12-month pre-existing wait against the public list, state by state

Here is one Australian case with the dates worked out. Helen is 62. Her knee has ached since August 2026, and her GP has referred her to an orthopaedic surgeon. She has no hospital cover. On 1 December 2026 she takes out a policy that includes joint replacements.

The private route. If the insurer’s appointed doctor decides the knee had symptoms in the 6 months before 1 December 2026, the joint replacements benefit for that knee starts after a 12-month wait: 1 December 2027 (PrivateHealth.gov.au waiting periods, read 8 November 2026). She then needs a date on the surgeon’s list, and pays 12 months of premiums before the policy pays anything for the knee.

The public route. If a public surgeon had listed her as ready on the same day, the table shows when half of patients in her state were admitted, using each state’s 2024–25 median.

Sources: AIHW MyHospitals ES 2024-25; Medical Costs Finder 2023–24; PrivateHealth.gov.au. Dates are Plain Cover arithmetic. Last verified 8 November 2026.

In six of the seven states with published figures, the public median date falls before the private benefit starts. Only in the ACT does the 12-month pre-existing wait end first, by 23 days. A median is not a promise: half of public patients wait longer, and 31.3% in New South Wales waited more than a year. The public clock also starts only after a public specialist appointment, which can itself take months.

If the insurer decides the knee was not pre-existing, the general 2-month wait applies and the benefit starts on 1 February 2027.

What should you ask the surgeon about the known gap before booking?

Ask before you agree to a knee replacement date. In Australia this is informed financial consent, and the Medical Costs Finder suggests asking the specialist for an estimate and asking the insurer how much it will cover (read 8 November 2026). For a knee replacement in 2026–27, these questions cover the whole team:

1. Which MBS item will you bill, 49518, 49517 or another, and what is your fee?
2. Will you bill under my insurer’s no gap or known gap arrangement for this admission, and what is my gap in dollars?
3. Who is the assistant surgeon, and will they also use the gap arrangement? Their MBS item 51303 fee is one-fifth of yours.
4. Who is the anaesthetist, and how do I get their written estimate? Anaesthetic items start at A$165.90 for item 21402, plus time.
5. Which hospital, and does it have an agreement with my insurer?
6. Is the knee implant on the Prescribed List, and will there be any device gap?
7. Will rehab be inpatient or at home, and how will my policy pay for it?

Then call the insurer with the item numbers. It can confirm that joint replacements is covered on your policy, whether your waiting periods are served, and the benefit for each item. Compare the quotes with the Medical Costs Finder’s typical knee replacement figures for your state. Each doctor’s known gap is charged separately, so a surgeon, assistant and anaesthetist on a known gap are three amounts, not one. How insurers set those limits is in our gap fees guide.

How do people weigh going private or waiting for a knee replacement?

There is no single right answer, and the medical side, including how urgent the operation is, is for the treating doctor. On cost and timing alone, the AIHW and Medical Costs Finder figures point in different directions depending on the situation. The table sets out what the 2024–25 and 2026–27 numbers show for each.

Sources: AIHW MyHospitals ES 2024-25; Medical Costs Finder 2023–24; PrivateHealth.gov.au. Last verified 8 November 2026.

People in Helen’s position typically weigh the premium for a year against the gap and the time saved, if any. The yearly cost of hospital cover by tier is in our guide to what private health insurance costs, and how waiting periods carry across funds is in our hospital waiting periods guide. To see policies that include joint replacements for your age and state, you can compare hospital cover.

This is general information only. It does not take your health, finances or needs into account, and it is not medical advice.