Will Mass Health Cover Knee Surgery?

by | Last updated on January 24, 2024

, , , ,


MassHealth considers approval for coverage of knee arthroplasty on an individual, case-by-case basis

, in accordance with 130 CMR 450.204. Arthroplasty describes the surgical replacement or reconstruction of a joint with implanted devices when the joint has been damaged by an arthritic or traumatic process.

How long do you have to be off for knee surgery?

You should be able to do many everyday activities 3 to 6 weeks after your surgery. You will probably need to take

4 to 16 weeks

off from work. When you can go back to work depends on the type of work you do and how you feel.

Can you request knee surgery?

It may be time to have knee replacement surgery if you have:

Severe knee pain that limits your everyday activities

. Moderate or severe knee pain while resting, day or night. Long-lasting knee inflammation and swelling that doesn’t get better with rest or medications.

Is hospitalization required for knee replacement?


Most knee replacement surgeries require a stay at the hospital

, especially if you’re undergoing total knee replacement. A stay in the hospital allows Dr. Karas to more closely monitor your recovery and initiate physical therapy when you have the full support of the experienced medical staff.

How much does a knee surgery cost?

Studies show that total average cost for a knee replacement in the United States in 2020 is somewhere

between $30,000 and $50,000

. But it can be confusing to figure out what that price tag includes. In many cases, some insurers – like HealthPartners – can bundle costs for your surgery and post-op rehab.

How long does it take for insurance to approve knee replacement?

The process of receiving approval for surgery from an insurance carrier can take from

1-30 days

depending on the insurance carrier. Once insurance approval is received, your account is reviewed within our billing department.

What age is good for knee replacement?

Doctors do sometimes recommend that people

under age 60

wait to undergo a knee replacement procedure, because these artificial joints typically last only about 15 to 20 years. If someone younger gets the procedure, it’s likely that the joint will need to be replaced again down the line.

Can you go home the same day after knee replacement?

Outpatient knee replacement surgery, also called “rapid-recovery knee replacement,” “same-day knee replacement” or “ambulatory knee replacement,” is a total knee replacement procedure that

allows qualified patients to return home on the same day of the operation

, rather than stay overnight on an inpatient basis.

How long after knee surgery can you drive?

Most patients may be able to get back to driving

between two to six weeks

after surgery. Your surgeon can recommend a plan for you to drive again based upon your specific outcome and recovery status. Taking steps to protect your knee after surgery will contribute to the success of your knee replacement.

Is knee surgery a major surgery?


A knee replacement is major surgery

, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, have not reduced pain or improved mobility. You may be offered knee replacement surgery if: you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced.

What happens if you wait too long for knee replacement?

Delaying Knee Replacement Surgery

May Diminish Health

The longer patients wait and allow their knee issues to affect them, the more it impacts overall health. For instance, an inability to walk without pain may lead to avoidance of exercise and weight gain which will put even more pressure on the painful knee.

How long can you delay knee replacement?

“A recent article in the Journal of Bone & Joint Surgery found that about 90 percent of people wait longer than necessary to have knee replacement surgery, often waiting

two years or more

beyond the point at which they are considered a reasonable candidate for the procedure,” Dr. Hansen said.

Are you put to sleep for knee replacement?

Because you remain conscious,

you will be given sedatives to relax you and put you in a light sleep

. The three types of regional anesthesia used most frequently in joint replacement surgery are spinal blocks, epidural blocks and peripheral nerve blocks.

Do you stay overnight after knee replacement?

Most patients having knee replacement don’t need to stay in the hospital very long.

Traditionally, patients stay in the hospital for one or two nights

. During that time, they work with physical therapists and occupational therapists to ensure they can move around and perform basic day-to-day functions.

Do they use a catheter during knee replacement surgery?

The knee will be well bandaged and leg will be propped up or elevated.

The patient may have a urinary catheter

, a drain at the incision site, and an IV delivering fluids. The catheter, if present, is often removed in the first few hours. The incision drain and IV may remain for the duration of the hospital stay.

What is the average hospital stay for a knee replacement?

The average hospital stay after total knee replacement is

three days

and most patients spend several more days in an inpatient rehabilitation facility. Patients who prefer not to have inpatient rehabilitation may spend an extra day or two in the hospital before discharge to home.

How much is a meniscus tear surgery?

The most common knee surgery performed on people over 65 is repair of torn meniscus cartilage. The procedure is costly, at

up to $10,000 a patient

— and it’s also usually a waste, if not outright harmful.

Can a torn meniscus be repaired?


Meniscus surgery is a common operation to remove or repair a torn meniscus

, a piece of cartilage in the knee. The surgery requires a few small incisions and takes about an hour. Recovery and rehabilitation take a few weeks.

Who should not have a knee replacement?

Two groups of people are at a significantly higher risk of potential rejection or loosening of their device and/or toxicity from wear particles.

Those with any type of allergy

. Even patients with allergies that are as simple as pollen or dander should avoid knee replacement surgery.

Is knee surgery painful?


Pain, swelling, and bruising are all normal after knee replacement surgery

, both for partial and total knee replacements. You’ll be sent home with oral pain medications after your surgery, which you’ll take for several weeks after your surgery.

What should you avoid before knee surgery?

Drugs and Supplements

Seven days before surgery:

Stop taking all NSAIDs (nonsteroidal anti-inflammatory drugs), such as naproxen (Aleve), ibuprofen (Advil, Motrin) and aspirin

. They interfere with blood clotting, which can increase blood loss during surgery.

Will a knee replacement get rid of arthritis?

Knee surgery may temporarily relieve pain from arthritis, but

it does not cure the condition

. Managing your arthritis will still be necessary to reduce pain in the knees, even after joint surgery.

Do you need a knee replacement if you are bone on bone?

Bone-on-Bone Arthritis

Before considering knee replacement, the patient should have X-rays that show bone touching bone somewhere in the knee.

Patients who have thinning of the cartilage but not bone touching bone should not undergo knee replacement surgery, except in rare circumstances

.

What can you not do after knee surgery?

After your surgery,

avoid stools, sofas, soft chairs, rocking chairs, and chairs that are too low

. When getting up from a chair, slide toward the edge of the chair, and use the arms of the chair, your walker, or crutches for support to get up.

Kim Nguyen
Author
Kim Nguyen
Kim Nguyen is a fitness expert and personal trainer with over 15 years of experience in the industry. She is a certified strength and conditioning specialist and has trained a variety of clients, from professional athletes to everyday fitness enthusiasts. Kim is passionate about helping people achieve their fitness goals and promoting a healthy, active lifestyle.