Cromwell Hospital vs HCA vs Cleveland Clinic London: the £14k gap on the same knee replacement

Total knee replacement is the single most-priced private orthopaedic procedure in the UK. At three of London's flagship hospitals, the price for the same operation varies by £14,400. This is why.

The short answer

• Same TKR procedure, three London hospitals: £16,400 (Cromwell), £22,900 (HCA), £30,800 (Cleveland Clinic London)
• The £14.4k spread is driven by inpatient bed rate, imaging tariff and prosthesis mark-up
• Most Bupa and AXA policies cover all three, but member top-ups can hit £4,000–£8,000 at Cleveland Clinic London
• The Cromwell is uniquely still on all seven insurers' fully-covered lists in 2026

The benchmark

We benchmarked a total knee replacement (TKR) — the single most standardised private orthopaedic procedure in the UK — across three flagship London private hospitals in Q2 2026. Same procedure code, same length of stay (2 nights inpatient), same physiotherapy schedule (5 sessions). The three published all-in package prices for a self-pay patient came out as follows.

Total knee replacement, self-pay package price, London Q2 2026

• Price gap Cromwell → Cleveland: +£14,400 (Published package prices, June 2026)
• Bupa members with fully-covered access to all three: ~64% (PremierPMI Bupa book 2026)
• Cleveland Clinic London top-up on standard Bupa policy: £4,000–£8,000

What the £14,400 buys

The gap is not consultant fee (which is broadly the same across the three sites for a senior orthopaedic surgeon) and it is not the prosthesis (a Stryker or Zimmer Biomet component is the same wholesale cost anywhere in the UK). It is the inpatient tariff. Cleveland Clinic London runs at roughly 2.1x the inpatient bed rate of the Cromwell, driven by staff-to-patient ratio, imaging equipment (a dedicated MRI theatre), and the operational model — every room is a suite. The Wellington sits in the middle, with London Bridge Hospital slightly below it and The Portland slightly above.

"The uncomfortable truth of top-tier London private orthopaedics is that the clinical outcome data at 90 days post-op is essentially identical between the Cromwell and Cleveland Clinic London. What you are paying £14,400 more for is hospitality, private nursing ratios and imaging depth — not the operation itself." — Tumaris, Director, PremierPMI

Which PMI products cover which

PMI coverage matrix, TKR at flagship London hospitals, 2026

The Cromwell exception

The Cromwell — owned by Bupa but operated as an independent hospital — is the only London flagship that sits on all seven insurers' fully-covered networks in 2026. This is a structural anomaly (Bupa cannot exclude its own hospital, and the other insurers benefit from the same tariff Bupa negotiated for itself). For members whose consultant admits at the Cromwell, it is almost always the correct choice on pure economics.

The three questions to ask your consultant

• Where else do you admit? Most senior consultants have privileges at 2–4 sites.
• What is the total package price at each? Ask for a written estimate under Consumer Rights Act 2015.
• Is my insurer's schedule fully accepted at each site? A yes at the Cromwell but a no at HCA changes the maths.

PremierPMI is a UK private medical insurance broker specialising in whole-of-market placement across 10+ leading UK health insurers including Bupa, AXA Health, Aviva, Vitality, WPA, Freedom Health, The Exeter, General & Medical and National Friendly. FCA regulated (Tesha Family Ltd, FRN 1029667). Speak to a broker on 020 4525 0884, WhatsApp 020 8064 2273, or email contact@premierpmi.co.uk.