Senior Director, Joint Replacement Programme, BLK-Max Super Speciality Hospital, New Delhi
Part 8 of 9 in Diagnosis & Management of Degenerative Joint Disease
Beyond the Knee: Hip, Shoulder and Elbow Replacement in Degenerative Joint Disease
September 6, 2026
Degenerative joint disease is often discussed as a knee condition, but Dr. Ishwar Bohra's Jivo Healthcare masterclass covered the hip, shoulder and elbow in equal depth, each with its own presentation and its own replacement option.
Hip arthritis in younger patients
Dr. Bohra highlighted avascular necrosis of the femoral head as an increasingly common cause of hip arthritis in a younger population, distinct from the age-related wear that drives most knee osteoarthritis, and noted a rise in cases following COVID-19. Bilateral hip replacement, sometimes with major bone loss requiring the surgeon to reconstruct a shell and stem to reproduce the joint, is the option he described for the most advanced of these cases.
Shoulder replacement for complete cartilage loss
For a shoulder with complete loss of articular cartilage and surrounding muscle, Dr. Bohra described reverse shoulder arthroplasty, in which the normal ball-and-socket orientation of the joint is deliberately reversed, as the option that restores function in a joint that otherwise has none left. He presented a case in which a patient with zero shoulder function before surgery regained meaningful use of the joint afterward.
Elbow replacement in rheumatoid disease
Rheumatoid arthritis patients, in Dr. Bohra's experience, are the group most often affected by elbow arthritis, sometimes to the point of being unable to move the joint at all. Elbow replacement in these patients restores the ability to carry out basic daily activities, in his words, eating food and managing morning and daily routines, functions that a stiff, crippled elbow otherwise takes away entirely.
One underlying disease, several joints
The common thread across all three joints, Dr. Bohra told the doctors on the call, is that the underlying disease process, cartilage loss driven by joint integrity, biochemical change, genetics and mechanical stress, is the same one described earlier in this series for the knee. What differs by joint is the replacement technique and the point at which it becomes the right recommendation.
This guide is based on a live Jivo Masterclass: Dr. Ishwar Bohra taught doctors across Africa on April 27, 2025.
FROM THE LIVE Q&A
Dr. Olimei
What is the total cost of doing a total knee replacement, in dollars?
Dr. Ishwar Bohra
Approximate cost in my own practice runs around 7,000 to 7,500 US dollars, depending on the patient's room selection and other choices. India, and our hospital specifically, offers one of the most subsidised rates in the world compared with the West and the rest of Asia.
Frequently Asked Questions
Is there a relationship between vitamin D deficiency and osteoarthritis?▼
Definitely, because vitamin D is essential in bone metabolism: it regulates the calcium, magnesium and phosphorus that are the key minerals of bone strength. If vitamin D is low, the subchondral bone that gives cartilage its strength becomes weak, so the cartilage starts to wear and the bone becomes soft and malaligned, which leads to arthritis. This is a major contributory factor that often isn't picked up clinically, so once a patient is diagnosed with hypovitaminosis D, it should be corrected immediately to avoid future complications.
Is total knee replacement indicated for children with juvenile idiopathic arthritis?▼
Hip replacement can be done even after 13 to 14 years of age, but knee replacement has to wait until 18, because the longevity of implants in children is not very good and outcomes are worse than with hip replacement. If a child is severely affected, knee replacement can be considered after age 16 to 18; before that, an alternative non-replacement approach, such as bracing, is used to manage the pain.
Is there any risk of malignant transformation in a patient with a malunited tibia fracture of more than 10 years' duration without treatment?▼
No, a malunited fracture carries no risk of malignant transformation.
What is the total cost of doing a total knee replacement, in dollars?▼
Approximate cost in my own practice runs around 7,000 to 7,500 US dollars, depending on the patient's room selection and other choices. India, and our hospital specifically, offers one of the most subsidised rates in the world compared with the West and the rest of Asia.
What causes hip arthritis in younger patients?▼
Avascular necrosis of the femoral head is an increasingly common cause in younger patients, distinct from the age-related wear that drives most knee osteoarthritis, and Dr. Bohra noted a rise in cases following COVID-19.
What is reverse shoulder arthroplasty used for?▼
Cases of complete articular cartilage and muscle loss in the shoulder, where the ball-and-socket orientation of the joint is deliberately reversed to restore function to a joint that otherwise has none.
Who typically needs elbow replacement?▼
Rheumatoid arthritis patients, in Dr. Bohra's experience, are the group most often affected by elbow arthritis severe enough to require replacement.
In This Series: Diagnosis & Management of Degenerative Joint Disease
- 1.Diagnosis and Management of Degenerative Joint Disease
- 2.Degenerative Joint Disease: Risk Factors and How to Diagnose It in Clinic
- 3.Managing Early Osteoarthritis Without Surgery: Lifestyle, Bracing and Medication
- 4.High Tibial Osteotomy and Partial Knee Replacement: Preserving the Joint Before Full Replacement
- 5.Total Knee Replacement for Advanced Osteoarthritis: Indications and Long-Term Survival
- 6.Robotic Joint Replacement: Closing the Gap Between a Working Knee and a Happy Patient
- 7.Complex and Infected Joint Replacement Cases: What a Revision Surgery Actually Involves
- 8.Beyond the Knee: Hip, Shoulder and Elbow Replacement in Degenerative Joint Disease
- 9.The Real Cost of Total Knee Replacement in India