Most practices price a Google Ads click against the visit it books. In orthopedics that's the wrong receipt. The visit is a consult. The consult may become a knee replacement months later. And for a big share of knee patients, the replacement comes with a sequel: the other knee.
Price the click against the first visit alone and the budget looks expensive. Price it against the patient, both knees and all, and the same click starts to look cheap.
A Knee Replacement Click Buys a Consult, Then Maybe a Surgery, Then Maybe Another
Picture one search: "knee replacement surgeon." The click lands on your page, the person books a consult, and that's where Chapter 1's tracking stops counting. What happens next never shows up in the Google Ads account. The surgeon recommends injections and therapy first. The patient comes back after the imaging. Surgery gets scheduled for the fall. And a few years later, the knee on the other side starts sounding like the first one did.
Every one of those steps changes what that first click was worth. This chapter walks the chain link by link, with real numbers where they exist and a clear label where they don't, so you can set a budget on the whole patient instead of the first appointment.
Six Links Sit Between a Click and a Surgical Patient
The method prices every click through the same chain:
- Cost per click: what you pay each time someone taps the ad.
- Conversion rate: the share of clicks that book a consult.
- Cost per consult: the click cost divided by that rate.
- Consult-to-surgery rate: the share of consults that end in surgery.
- Cost per surgical patient: the consult cost divided by that rate.
- Lifetime value: everything that patient is worth to the practice, over time.
Here is the chain with orthopedic numbers. Treat it as an illustration built from real ranges, not a forecast for your practice.
Start with the click. In our example market, Nashville, Keyword Planner puts top-of-page bids for knee replacement searches at about $1.45 to $3.44. Nationally, "knee replacement surgeon" runs $1.44 to $5.82. Call it $4 a click, near the top of those ranges, to stay conservative.
Next, the conversion rate. A marketing vendor's 2026 benchmark for physician and surgeon search ads puts it at about 12%. That comes from one company's own customer accounts, so treat it as weak and use your own rate the moment Chapter 1's tracking gives you one. At 12%, a $4 click works out to about $33 per booked consult.
Then the step that matters most in orthopedics. Say a quarter of those consults end in surgery. A $33 consult becomes about $133 per surgical patient.
That's the whole chain, and each link multiplies the one before it. Two of the six links are yours to improve. The click price mostly isn't.
Most Consults Don't End in Surgery. That Rate, Not the Click Price, Sets Your Budget.
The 25% above was a placeholder, and the real range is wide. In a peer-reviewed study of a spine practice that took new patients without screening, 15% of them ended up in surgery. In another spine group that screened its referrals, 41.6% did, with individual surgeons ranging from about 25% to 60%. We found no published rate for knee or joint replacement practices, so your own number is the only one that counts.
Run the same $33 consult through both ends of that range. At 15%, a surgical patient costs about $222. At 41.6%, about $80. Same ads, same clicks, same budget, and the cost of a surgical patient moves almost threefold.
That spread comes from the practice, not from Google. The groups at the high end screen: they book the right surgeon for the problem, get imaging done before the visit, and make sure the patient who needs surgery doesn't leave the consult without a plan. The front desk matters here too. In our sample of 882 patient reviews, front desk and phone problems were the top complaint in one- and two-star reviews, 37 of 73. A consult that never gets scheduled because nobody called back has a surgery rate of zero.
Four in Ten Knee Patients Are Back for the Other Knee Within Eight Years
Now the part most budgets leave out. Knee arthritis rarely stays on one side. In a long-running study of Olmsted County's residents, 45% of patients who had one knee replaced had the other knee replaced within 20 years. In a multicenter US study that followed patients for eight years, the figure was 40%. A national registry in the Netherlands found about 36% within ten years, with the second surgery coming a little over two years after the first on average, though that's a health system outside the US. Hips run lower: 29% within 20 years in the Olmsted County study.
What does a surgery pay? For a total knee replacement, Medicare's surgeon fee comes to about $1,159 nationally in 2026, before local adjustment. That's our calculation from Medicare's published fee files, and the fee covers the surgery plus 90 days of routine follow-up. Commercial plans pay more: a 2021 Urban Institute study found commercial rates for that same knee code at about 1.6 times Medicare. A practice that owns a surgery center also collects a facility payment. Medicare paid surgery centers about $8,472 per knee replacement in 2022. Revenue from the physical therapy, imaging and bracing that often go with a joint patient is real, but we found no reliable published figure for it, so it's left out of the math.
Put those together and a knee patient is worth the first surgery plus roughly 40% of a second one within a decade. That's the "both" in this chapter's title. You're not paying for one knee. You're paying for one knee and a strong chance at the other.
You Can Price In the Second Knee. You Can't Advertise to It.
Here's where orthopedics differs from a business that sells refills. The obvious move would be to upload your patient list and run ads to everyone with one new knee. Don't.
HIPAA requires that a practice get a patient's written authorization before it uses their information for marketing, and a list that says "these people had knee surgery here" is exactly that information. Google adds its own limits: health is a sensitive category, remarketing and patient-list targeting aren't allowed for it, and Customer Match targeting only opens to accounts with more than $50,000 in lifetime spend anyway.
So the second knee doesn't come from ads. It comes from good care, a surgeon the patient trusts and a follow-up plan that keeps them in your practice. What the second knee changes is how much you can afford to spend winning the first one. It belongs in your budget math, not in an audience list.
Word of Mouth Sends Patients You Never Paid a Click For
There's one more payment in the chain, and no report will show it. In the five-practice survey behind Chapter 2's referral numbers, 12.8% of patients came to the practice because a friend sent them. A patient who walks again without pain tells people, and in orthopedics people ask. Reviews carry the same effect to strangers.
We don't multiply word of mouth into the math, because we can't measure it for your practice and neither can you. Treat it as the margin of safety on top of the numbers you can count.
Your Highest Affordable Click Is Set by Knees Replaced, Not Consults Booked
Now run the chain backward, from what a surgical patient is worth to the most you can pay for a click. You need one decision the numbers can't make for you: what share of a surgery's value you're willing to spend to win it. Say you decide on a fifth of the surgeon's fee. Using Medicare's rates, that's about $232 per surgical patient.
- Counting one knee: $232 per surgical patient, at a 25% consult-to-surgery rate, allows about $58 per consult. At a 12% booking rate, that's a maximum of about $6.95 per click.
- Counting the expected second knee: the patient is worth about 1.4 surgeries, so a fifth of that is about $325. That allows about $81 per consult and about $9.74 per click.
Same practice, same ads, and the bid ceiling rises about 40% just by pricing the patient honestly. Swap in commercial rates or a surgery center's facility payment and the ceiling rises much further. That's why orthopedic practices that price on the first visit tend to underbid the searches that bring in their best patients.
Two more things to do before any of this becomes a real budget:
- Start small and read the real prices. Launch with a low daily budget so Google shows you actual bid estimates and costs in your market, then raise it once the numbers above have real data behind them.
- Send each click to the procedure's own page. The conversion rate in this chain depends on the page the ad lands on. A knee replacement click that lands on a knee replacement page books more often than one that lands on a home page. Chapter 4 covers why Google charges less for that match, too.
As the account builds data, it moves from these exact-match searches to broader campaigns. The usual pace is a couple of months for the next step, but the real gate is volume: about 30 quality consults a month, which a larger practice reaches sooner.
Next: Ad Groups Built Like Your Practice
You now know what a click can cost and still pay. Chapter 4 is about getting charged less for it: why Google rewards ads and pages that match the search, and why orthopedic ad groups should be built the way patients search, one body part at a time.
Which searches deserve this budget first is Chapter 2; every chapter, in order, is on the guide home.
When an orthopedic practice brings in our Google Ads management, this math comes before any bid: consult rate, surgery rate and the second knee, in their own numbers.
