Cost of Knee Replacement in Winston-Salem, NC – 2025 Complete Guide
Facing the cost of knee replacement surgery can feel overwhelming, especially when you’re already dealing with pain and limited mobility. The cost of knee replacement in Winston-Salem, NC, varies widely, and understanding what affects it can help you make informed decisions. This 2025 guide compiles data from trusted sources like the American Academy of Orthopaedic Surgeons, CMS.gov, and Healthcare Bluebook to give you a clear, up-to-date picture of what to expect. Whether you’re insured, uninsured, or somewhere in between, this guide is tailored to help you navigate your options confidently.
What is the average cost of knee replacement in Winston-Salem, NC?
The average cost of a total knee replacement in Winston-Salem, NC ranges from $30,000 to $55,000, depending on the facility and whether the procedure is inpatient or outpatient. According to Healthcare Bluebook, the fair price for a total knee replacement in this region is approximately $36,000. However, prices can vary significantly based on the hospital or surgical center you choose. The Centers for Medicare & Medicaid Services (CMS.gov) reports that Medicare reimbursement for knee replacement in North Carolina averages around $15,000–$20,000, which may not reflect the full cost billed to private insurers or patients paying out-of-pocket.
Costs may also differ based on whether the surgery is performed at a hospital or an ambulatory surgical center. In general, outpatient procedures tend to be less expensive. It’s important to request a detailed cost breakdown from your provider to understand what’s included in the estimate.
What factors affect the cost of knee replacement?
Several key factors influence the total cost of knee replacement surgery in Winston-Salem. According to the American Academy of Orthopaedic Surgeons (AAOS), these include the type of knee replacement (partial vs. total), the surgical setting (hospital vs. outpatient center), the surgeon’s fees, and whether advanced technologies like robotic assistance are used. Additionally, pre-operative imaging, physical therapy, and post-operative care can add thousands of dollars to the final bill.
Insurance coverage, deductibles, and whether the provider is in-network also play a major role. The Fair Health Consumer database shows that out-of-network services can increase patient costs by 30% or more. Furthermore, complications or extended hospital stays can raise the overall cost substantially. Patients should also consider the cost of durable medical equipment (e.g., braces, walkers), which may or may not be included in the quoted price.
Does insurance cover knee replacement?
Yes, most major insurance plans, including Medicare and Medicaid, typically cover knee replacement surgery when deemed medically necessary. According to CMS.gov, Medicare Part B covers 80% of the approved amount for outpatient knee replacement after the deductible is met, while Medicare Part A covers inpatient procedures. Private insurers like Blue Cross Blue Shield and Aetna also cover the procedure, but coverage details vary based on your specific plan and whether your provider is in-network.
The American Association of Hip and Knee Surgeons (AAHKS) notes that prior authorization is often required, and patients may need to demonstrate failed conservative treatments such as physical therapy or injections. Co-pays, deductibles, and coinsurance still apply, so it’s essential to verify your benefits with your insurance provider before scheduling surgery.
Are there payment plans or financing options available in Winston-Salem?
Yes, many orthopedic clinics and hospitals in Winston-Salem offer payment plans or third-party financing options to help manage the cost of knee replacement. According to Novant Health, which operates several facilities in the area, patients can apply for income-based financial assistance or set up monthly payment plans. Cone Health, another major provider in the region, also offers flexible billing options and partners with financing companies like CareCredit.
Additionally, some surgical centers provide bundled pricing packages for self-pay patients, which can reduce costs by 20–30%. These packages often include surgeon fees, anesthesia, and facility charges. Be sure to ask your provider about all available options, especially if you are uninsured or have a high-deductible health plan.
How does the cost in Winston-Salem compare to other North Carolina cities?
The cost of knee replacement in Winston-Salem is generally in line with other mid-sized cities in North Carolina but may be more affordable than in larger metro areas like Charlotte or Raleigh. According to Healthcare Bluebook, the fair price for a total knee replacement in Charlotte is around $38,000, while in Raleigh it can exceed $40,000 due to higher facility and provider fees.
Smaller cities and rural areas may offer lower prices, but access to specialized care and advanced technology may be limited. The North Carolina Department of Health and Human Services (NCDHHS) notes that urban centers often have more orthopedic specialists and surgical centers, which can improve outcomes but also increase costs. Patients in Winston-Salem benefit from a balance of affordability and access to high-quality care.
What’s included in the knee replacement cost?
The total cost of knee replacement usually includes several components: surgeon’s fees, anesthesia, facility fees (hospital or surgical center), pre-operative testing (X-rays, MRIs), and post-operative care such as physical therapy. According to the American Academy of Orthopaedic Surgeons, bundled pricing models often include all of these services in a single estimate, which can simplify billing and reduce unexpected charges.
However, not all providers offer bundled pricing. The Fair Health Consumer database shows that patients may receive separate bills for anesthesia, imaging, lab work, and durable medical equipment. It’s important to request a detailed cost breakdown and confirm whether follow-up visits and rehabilitation are included. If you’re insured, check which services are covered under your plan and whether any providers are out-of-network.
Do I need partial or total knee replacement, and how much does it cost?
Whether you need a partial or total knee replacement depends on the extent and location of joint damage. According to the American Association of Hip and Knee Surgeons, partial knee replacement is typically recommended when arthritis is confined to a single compartment of the knee. It’s less invasive, has a shorter recovery time, and generally costs 20–30% less than a total knee replacement.
In Winston-Salem, partial knee replacement averages between $20,000 and $35,000, while total knee replacement ranges from $30,000 to $55,000. The decision between partial and total replacement should be made in consultation with an orthopedic surgeon, who will evaluate your imaging results, symptoms, and activity level. Medicare and most private insurers cover both procedures when medically necessary.
How long does the knee replacement process take?
The entire knee replacement process—from initial consultation to full recovery—can take several months. According to the American Academy of Orthopaedic Surgeons, the surgical procedure itself typically lasts 1 to 2 hours. Most patients stay in the hospital or surgical center for 1 to 3 days, although outpatient procedures are becoming more common.
Post-operative recovery includes physical therapy, which usually begins within 24 hours of surgery and continues for 6 to 12 weeks. Full recovery and return to normal activities can take 3 to 6 months, depending on your age, overall health, and adherence to rehab protocols. Planning for time off work, transportation, and home support is essential for a smooth recovery process.
What is the success rate of knee replacement?
Knee replacement surgery is highly successful for most patients. The American Academy of Orthopaedic Surgeons reports that more than 90% of knee replacements are still functioning well 15 years after surgery. Success is typically measured by pain relief, improved mobility, and enhanced quality of life.
Factors that influence success include the surgeon’s experience, the patient’s health status, and adherence to rehabilitation. According to a study published in The Journal of Bone and Joint Surgery, patients who undergo surgery at high-volume centers tend to have better outcomes and fewer complications. In Winston-Salem, both Novant Health and Wake Forest Baptist Health are recognized for their orthopedic programs and offer comprehensive pre- and post-operative care to support long-term success.
Are there affordable alternatives to knee replacement?
Yes, there are several non-surgical alternatives to knee replacement that may be effective, especially in the early stages of arthritis. According to the American College of Rheumatology, options include physical therapy, weight loss, corticosteroid injections, hyaluronic acid injections, and medications like NSAIDs or disease-modifying antirheumatic drugs (DMARDs).
Platelet-rich plasma (PRP) and stem cell therapies are also being explored, though they are often not covered by insurance and can cost $1,000 to $5,000 per treatment. The effectiveness of these newer treatments is still under investigation. If your symptoms are manageable and your joint damage is not severe, your doctor may recommend trying these alternatives before considering surgery.
How can I find a qualified orthopedic specialist in Winston-Salem?
Finding a board-certified orthopedic surgeon is crucial for a successful outcome. The American Board of Orthopaedic Surgery (ABOS) provides an online directory where you can verify a surgeon’s credentials. In Winston-Salem, top-rated providers include specialists affiliated with Atrium Health Wake Forest Baptist and Novant Health Orthopedics & Sports Medicine.