- You do not need health insurance to have a private hip or knee replacement. You can pay for it yourself.
- A new insurance policy will not usually cover arthritis you already have.
- Some advertised prices leave out the surgeon and the anaesthetist. Always check what a price includes.
- Prices vary between regions, and between hospitals in the same city.
- Your choice of surgeon matters more than anything else. Check their experience and their results.
- NHS, insurance or paying yourself
- How self-pay works, step by step
- Is the price really all-inclusive?
- Why prices vary across the UK
- Why one hospital costs more than another
- How to choose your hip or knee surgeon
- What if something goes wrong?
- How Mr Hussain can help
- Self-pay hip and knee replacement FAQs
NHS, Insurance or Paying Yourself: Which Route Suits You?
There are three ways to have a hip or knee replacement in the UK.
| Topic | NHS | Insurance | Self-pay |
|---|---|---|---|
| Who pays | The NHS. It is free to you. | Your insurer, less any excess | You, usually before the operation |
| How to start | A GP referral | Usually a GP referral, plus approval from your insurer | You can usually book directly. A GP letter helps. |
| Waiting time | Varies by hospital. Check your local wait. | Usually weeks | Usually weeks |
| Choice of surgeon | Limited. In England you can choose your hospital. | Your choice, from your insurer's list | Your choice |
| Arthritis you already have | Covered | Usually not covered by a new policy | Covered |
| What to check | Your hospital's waiting time | Your excess, and that your surgeon and hospital are covered | What the price includes and leaves out |
Not insured? You can still go private
If you have no health insurance, you can still have a private hip or knee replacement. Self-pay simply means paying the hospital and surgeon yourself, with no insurer involved. You can usually book a consultation directly, without a GP referral. Most private hospitals offer a fixed price for a hip or knee replacement.
Why new insurance will not cover your arthritis
Health insurance is designed for new problems that start after you take out cover. Insurers call problems you already have pre-existing conditions. A new policy will not normally pay for treating them.
So if your hip or knee is already painful, buying a policy now will not usually pay for the operation. Some workplace schemes are more generous. Check with your employer.
If you already have insurance, read our guide to getting insurance approval for hip or knee surgery.
Having your operation on the NHS
The NHS remains a good option for many people. In England, you have a legal right to choose which hospital your GP refers you to. This can include some private hospitals that treat NHS patients. Waiting times vary a great deal, so it is worth checking your local wait.
You can read how NHS patients can be referred to Mr Hussain on our FAQ page.
How Self-Pay Works, Step by Step
- Book a consultation. You can usually contact the surgeon's team directly. The first consultation is charged separately.
- Have an assessment. The surgeon examines you and looks at your X-rays. Sometimes a scan is needed.
- Get a written quote. If surgery is right for you, ask for a fixed price in writing. Check what it includes.
- Have a pre-operative check. This is usually a few weeks before surgery. It makes sure you are fit for the operation.
- Have your operation. Most people pay before the operation.
- Recover and attend your check-ups. Ask in advance whether these are included in the price.
You can read how this works with Mr Hussain on our page about private orthopaedic surgery in Birmingham.
Is the Price Really All-Inclusive?
Not always. This is the most common surprise for people who pay for themselves.
PHIN is the official body that publishes information on private healthcare. It says you will often get three separate bills:
- one from the hospital
- one from your surgeon
- one from your anaesthetist
This happens because surgeons and anaesthetists often do not work for the hospital. They are independent doctors who set their own fees.
Why some prices look surprisingly low
Some hospitals advertise their own fee only. The surgeon's and anaesthetist's fees are then added on top. Follow-up appointments may be extra too.
So a low headline price can end up costing more. Always compare the total cost, not the first figure you see.
What a package price usually leaves out
Even a true package price has limits. Things that are often extra include:
- the first consultation
- X-rays, scans and blood tests before you decide to have surgery
- extra nights in hospital
- a stay in a high dependency unit
- treatment for a complication
- Is this a fixed package price?
- Does it include the surgeon's fee?
- Does it include the anaesthetist's fee?
- Does it include the implant?
- How many nights in hospital does it cover?
- Are check-ups after surgery included?
- What happens, and who pays, if there is a complication?
Your surgeon must, by law, tell you their fees in writing. Ask the hospital for its part in writing too.
You can see exactly what our hip and knee replacement prices include on our fees page.
Why Prices Vary Across the UK
The same operation can cost thousands of pounds more in one part of the country. There are a few reasons.
- Local competition. Some areas have only one or two private hospitals. The UK competition regulator found that weak local competition can push up prices for people who pay for themselves.
- London. Central London prices are usually the highest. The regulator found that one hospital group there charged more than a well-run market would allow.
- Running costs. Buildings, land and staff all cost more in some areas.
- What is included. One hospital's price may cover more than another's.
A higher price does not always mean better care. A lower price does not always mean worse care. What matters most is who does your operation, and what the price includes.
Why One Hospital Costs More Than Another
The same surgeon can charge different prices at different hospitals, even in the same city. This often surprises people.
The surgeon, the anaesthetist and the type of implant can all be the same. Only the hospital is different. This is because the hospital fee is the largest part of the price. Each hospital sets its own fee. Reasons it varies include:
- Facilities. Some hospitals have intensive care beds and doctors on site day and night. These cost more to run.
- Ownership. Some private units are part of NHS hospitals. Others belong to private hospital groups.
- Buying power. Each hospital or group agrees its own prices for implants and supplies.
- What the package covers. The number of nights, check-ups and cover for problems all vary.
- Rooms and comfort. Food, rooms and parking differ between hospitals.
Private care in NHS hospitals
Some NHS hospitals have their own private units. Their profits are put back into the NHS. So paying for private care in one of these units also helps NHS patients.
How to Choose Your Surgeon
Your choice of surgeon is probably the most important decision you will make. It matters more than the hospital or the price.
Why experience matters
Surgeons who do more of an operation tend to get better results. A national study looked at about 580,000 hip replacements in England and Wales. Patients of the busiest surgeons were much less likely to need their hip redone.
The same pattern is seen in knee replacement. It is strongest for partial knee replacement.
For a redo operation, experience matters even more. Ask your surgeon how often they do revision surgery, and where complex cases are treated.
Five free checks
You can check any UK surgeon in a few minutes.
- GMC register. Check that your surgeon is on the specialist register for trauma and orthopaedic surgery.
- National Joint Registry. See how many hip or knee replacements they do, and how often they need redoing.
- PHIN. See how many private operations they do, and their fees.
- CQC. Check the rating of the hospital.
- Reviews. Read what other patients say, on an independent review site.
You can read our guide on how to read your surgeon's NJR results.
A good surgeon will explain the risks honestly. They should also tell you if an operation is not right for you.
What If Something Goes Wrong?
Most hip and knee replacements go well. But it is wise to know where you stand before you pay.
- Ask what the price covers. Some packages include treatment for a complication. Others do not.
- Ask about extra nights. A longer stay may cost more.
- Ask who will treat you. Find out who you call at night or at the weekend.
- Ask where you would go. Find out what happens if you need intensive care.
Get the answers in writing before you agree to surgery.
How Mr Hussain Can Help
Mr Shakir Hussain is a consultant orthopaedic surgeon at the Royal Orthopaedic Hospital Birmingham. He specialises only in hip and knee joint replacement and resurfacing surgery. He sees private patients at three Birmingham hospitals:
- the Woodlands Suite, Royal Orthopaedic Hospital Private Care
- Priory Hospital Edgbaston
- Harborne Hospital
His package prices include the surgeon, the anaesthetist, the implant, the hospital stay and routine check-ups after surgery. You get a fixed written quote after your consultation.
Frequently Asked Questions
Can I have a private hip or knee replacement without insurance?
Yes. You can pay for it yourself, and you do not need any insurance. This is called self-pay. You can usually book a consultation directly, often without a GP referral. If surgery is right for you, most hospitals offer a fixed package price. Always check what that price includes before you agree.
How quickly can I have surgery if I pay for myself?
Usually within weeks. You can often see a surgeon within a week or two of contacting them. If you decide to go ahead, surgery is usually possible a few weeks later. You will need a pre-operative check first, to make sure you are fit for the operation. The exact timing depends on the surgeon, the hospital and your health.
Will a new insurance policy cover my hip or knee replacement?
Usually not. Health insurance is designed for new problems that start after you take out cover. If your hip or knee was already painful, or you had seen a doctor about it, insurers treat it as a pre-existing condition. A new policy will not normally pay for the operation. Some workplace schemes are more generous, so check with your employer.
Do I need a GP referral to pay for my own operation?
Usually not. Most private surgeons will see self-pay patients directly. A letter from your GP still helps, because it gives the surgeon your medical history, medicines and any recent tests. If you have insurance, your insurer will usually ask for a GP referral first.
Can I come off the NHS waiting list to go private?
Yes. You can choose to have your operation privately at any time. Paying for private care does not affect your right to NHS care for anything else. If you go private for your operation, tell your GP and your NHS hospital, so your place on the waiting list can go to someone else. If you see a surgeon privately but then have the operation on the NHS, the private appointment does not move you up the NHS waiting list.
Does a private price include the surgeon and anaesthetist?
Not always. Some advertised prices cover only the hospital fee. The surgeon and anaesthetist then send their own bills. Ask whether the price includes the surgeon's fee, the anaesthetist's fee, the implant and check-ups after surgery. Then get the total price in writing before you agree to surgery.
Why does the same operation cost more at one hospital than another?
The hospital fee is the largest part of the price, and each hospital sets its own. Hospitals differ in their facilities, such as intensive care beds and doctors on site at night. They also differ in who owns them, what they pay for implants, and what their package covers. So the same surgeon can charge different prices at different hospitals. A higher price does not always mean better care.
How do I choose a good hip or knee surgeon?
Choose a surgeon who does your operation often, because surgeons who do more tend to get better results. Check they are on the GMC specialist register for trauma and orthopaedic surgery. Look at their results on the National Joint Registry, and how many private operations they do on PHIN. Read independent patient reviews. A good surgeon will explain the risks honestly and tell you if surgery is not right for you.
What happens if there is a complication after a self-pay operation?
It depends on your package. Some packages include treatment for complications, such as extra nights in hospital or a return to theatre. Others charge extra. Ask what is covered, who will look after you at night and at weekends, and where you would go if you needed intensive care. Get the answers in writing before you pay.
References
- Private Healthcare Information Network (PHIN). About private hospital pricing in the UK.
- Private Healthcare Information Network (PHIN). What patients should know about private consultant fees and other healthcare costs.
- Private Healthcare Information Network (PHIN). Paying for treatment with private medical insurance.
- Competition and Markets Authority. CMA finalises changes for private healthcare. Private healthcare market investigation, 2014.
- NHS England. Elective recovery: a partnership agreement between the NHS and the independent sector.
- Association between surgical volume and failure of primary total hip replacement in England and Wales: findings from a prospective national joint replacement register. BMJ Open. 2020. Full text
- Liddle AD, Pandit H, Judge A, Murray DW. Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Joint Surg Am. 2016;98(1):1-8. Abstract
This page is for general information and is not financial or medical advice. Always confirm prices and what they include in writing with your surgeon and hospital.
Mr Shakir Hussain
Consultant Hip and Knee Surgeon in Birmingham, with over 5,000 procedures and certification on all three major robotic knee platforms: MAKO, ROSA, and CORI.