Hip and knee replacement: funding sources, cost structure and treatment abroad

What is joint replacement and why is funding a separate issue?

Joint replacement means replacing the damaged surfaces of a joint, or the whole joint, with an artificial implant. It is most often done on the hip and knee, for example for severe osteoarthritis, a fracture of the femoral neck or bone necrosis. Before surgery the doctor assesses the condition of the joint, the patient's age, other conditions and level of physical activity, so when, where and with which prosthesis the operation is done is a decision for the treating orthopaedic surgeon and the anaesthetist, not for the funding source.

Financially, joint replacement differs from other planned operations for two reasons. First, a large part of the cost is the implant itself, whose price varies considerably by manufacturer and type. Second, the basic Universal Healthcare package explicitly excludes orthopaedic joint replacement, so for most families the first question is not "which programme do I qualify for" but "is there any setting in which a programme works for me at all".

The information below is based on the consolidated text of Government Resolution No. 36 of 2013 as of 18 September 2026, the 2026 state healthcare programmes and the 2026 rules of the Tbilisi City Council.

When does Universal Healthcare cover the operation?

The list of exclusions in the basic Universal Healthcare package includes organ transplantation, external prosthetics and orthopaedic joint replacement, with one exception in brackets: an injury less than 3 months old that cannot be, or could not be, treated conservatively. Outside this framework, three situations are handled differently.

1. A recent injury

If the joint has to be replaced because of an injury sustained within the last 3 months, for example a fracture of the femoral neck, and the doctor confirms that conservative treatment is not working, the case is considered under the programme. The date is critical here: the date and mechanism of the injury must be recorded accurately in Form IV-100/a and in the discharge summary, because that is what proves the 3-month period has not passed.

2. Socially vulnerable and protected groups

Annex 1.3 to Resolution No. 36, which describes the package for socially vulnerable people and those treated as equivalent, as well as for children aged 0-5, pensioners, students and persons with disabilities, has its own list of exclusions. That list includes organ transplantation and external prosthetics, but not orthopaedic joint replacement. In practice this means that for these groups the operation can be funded under the planned surgery component, within the annual limit of GEL 15,000 and the category's co-payment. The Tbilisi rules indirectly confirm this: a beneficiary under Annex 1.3 cannot use the City Hall joint replacement sub-programme, and neither can anyone who turns down joint replacement offered by the Ministry.

3. Haemophilic arthropathy

For patients with haemophilia and other inherited bleeding disorders, the 2026 state programme for rare diseases specifically provides for replacement of a joint damaged by haemophilic arthropathy. The operation is funded on the diagnosis-related groups (DRG) principle, in full and with no co-payment, and an April 2026 amendment allocated a separate budget amount to this area.

City Hall, the referral commission and insurance: where to find the rest?

If none of the situations above applies to you, the cost of the operation is covered from local and individual sources. Each has its own logic:

• Tbilisi City Hall. The "Funding for joint replacement" sub-programme funds hip and knee replacement up to a maximum of GEL 6,000, provided the person has been continuously registered in Tbilisi for the last 2 years before applying. The clinic sends the application through the electronic module, and you present the code you receive by SMS. The full mechanism with deadlines is in the guide to municipal assistance.
• Other municipalities. A dedicated joint replacement programme is rare, but many City Halls allow co-funding of planned surgery under their general healthcare programme, often subject to a social score or income condition. Ask whether the cost of the implant counts as part of the operation.
• Referral commission. The commission considers individual applications and sets the state's share according to the applicant's status. An unprepared joint replacement application is often weakened by the implant price not being shown separately in the cost estimate. How to write such an application is explained in the guide to the referral programme.
• Private insurance. Some policies exclude joint replacement or cover it only after an injury. If you apply to the Tbilisi sub-programme, City Hall will still ask for an insurance statement, so get a written answer from your insurer in advance.

One detail that matters if both joints need surgery: under the Tbilisi rules, the same type of service is funded only once per budget year. If the doctor plans two stages, ask the department in advance how the second operation will be treated and whether it is worth scheduling it for the following year.

What makes up the cost of the operation and what is left for the family?

We do not give exact prices here, because they vary with the clinic, the implant and the complexity of the case. Knowing how a cost estimate is structured, however, helps you compare offers and see which part each source covers:

• Implant: the manufacturer, model and type of fixation (cemented or cementless) should be on a separate line;
• Surgery and anaesthesia: the cost of the surgical team, operating theatre and pain relief;
• Inpatient stay: bed days, medicines and post-operative tests;
• Pre-operative tests: laboratory tests, X-rays and consultations where needed;
• Rehabilitation: a course of physiotherapy, which is often not included in the cost estimate at all;
• Mobility aids: crutches or a walking frame, which the family buys or hires separately.

A municipal programme usually covers a fixed upper limit, and the difference between the actual cost and that limit remains as a co-payment. So before applying for funding, ask the clinic for a cost estimate in two versions, with different implants: this shows how much your share changes, while the choice of which prosthesis suits your condition should be made with your doctor. For rehabilitation, caregivers and equipment, our medical equipment service can also help.

Funding sources in one table

The table summarises the rules in force in 2026. Funding from any source is set by a specific decision and is not guaranteed in advance; Solidaroba.ge does not represent any state or municipal body.

When do people choose joint replacement abroad and what does a foreign clinic ask for?

Families usually consider going abroad in three situations: when a revision operation is needed, that is, replacing a previously implanted prosthesis; when the case is non-standard, for example after a congenital joint deformity or previous operations; and when the patient wants the experience of a particular centre or surgeon. Frequently considered destinations are Turkey, Germany, Austria and India; we have a separate guide for each: Turkey, Germany, Austria and India.

Bear in mind that Universal Healthcare and municipal programmes do not cover services provided abroad. The only realistic route to state co-funding is the referral commission, which requires an opinion from the Ministry's specialist expert that the operation cannot be done in Georgia. Such an opinion is hard to obtain for standard primary joint replacement, so families mostly plan surgery abroad with their own money or insurance.

What the clinic asks for a preliminary assessment

• digital X-rays of the joint, including the views needed for surgical planning that the clinic specifies;
• a CT or MRI scan, if one has been done, with its report;
• the orthopaedic surgeon's report and Form 100 with the diagnosis given as an ICD-10 code;
• a list of other conditions and regular medicines, especially blood thinners;
• for a revision, the report of the previous operation and the details of the implant: manufacturer, model, size.

Our clinic search service can help you choose a clinic, compare prices and prepare the visa. Agree the timing of your flight after the operation with your treating doctor.

The document package and translation

Whether it is a City Hall application, the commission or a foreign clinic, the basic package is almost the same. The difference lies in the language and the certification.

1. Form IV-100/a

   The diagnosis as an ICD-10 code, a description of the procedure and, for an injury, its date. For the Tbilisi sub-programme the certificate must not have been issued more than 3 months before the request is registered. A sample is in the Form 100 guide.

2. Imaging with reports

   X-rays and CT scans, both the images and the radiologist's report. For a foreign clinic, the reports are translated into English or the clinic's language.

3. An itemised cost estimate

   The cost of the implant on a separate line. For the commission, a foreign cost estimate is translated into Georgian and notarised.

4. Discharge summary after the operation

   After surgery abroad, have the discharge summary and the implant details translated into Georgian: your rehabilitation specialist, your family doctor and any future revision will need them.

Translation of imaging reports is described on the imaging report translation page, discharge summaries on the discharge summary translation page, and the Translation price calculator shows an indicative price. The full list of what a foreign clinic needs is in the guide to documents.

Frequently asked questions about joint replacement