Diagnosis and Management of Degenerative Joint Disease

Roughly one in eight people carries a musculoskeletal problem, according to 2018 registry data from the United States and Europe that Dr. Ishwar Bohra, Senior Director of the Joint Replacement Programme at BLK-Max Super Speciality Hospital, New Delhi, opened with in a Jivo Healthcare masterclass for doctors across Africa. Over more than two decades treating knee, hip and shoulder disease, he has watched degenerative joint disease grow into what he called a burden on the scale of the old infectious-disease epidemics, this time driven by age, obesity and diabetes rather than tuberculosis or leprosy. This guide draws on that session.

What osteoarthritis actually is

Osteoarthritis accounts for roughly 80 percent of all arthritis and is defined, per the American Association of Orthopaedic Surgeons, as damage caused by a complex interplay of joint integrity, biochemical processes, genetics and mechanical forces. In practice this means a gradual loss of articular cartilage, most often in the knee, hip and shoulder, at the points where the lateral and medial condyles, the acetabulum and femoral head, or the glenoid and humeral head articulate with each other.

The risk factors worth screening for

Dr. Bohra flagged age and female sex, particularly after 45 because of hormonal change, as leading risk factors, alongside obesity, prior knee injury, metabolic bone disease that leads to malalignment, repetitive joint stress from high-impact or physically demanding work, and muscle weakness that fails to keep cartilage surfaces properly separated. A basic office examination, using tests such as valgus and varus stress testing, the Lachman test for the ACL and PCL, the McMurray test for the menisci and a duck-waddle test for hip, knee and ankle stability, combined with a plain X-ray staged by the Kellgren-Lawrence system, is usually enough to confirm the diagnosis and decide whether a patient needs no intervention, rehabilitation or surgery.

A staged ladder from lifestyle to replacement

Management starts with the factors a patient can modify: weight, exercise and support. Physiotherapy-led quadriceps strengthening, range-of-motion exercise, swimming and cycling, combined with offloader braces and a cane or walker where needed, can hold early arthritis in check. Medical therapy layers on nutraceuticals such as glucosamine, chondroitin and collagen, analgesics including acetaminophen and COX inhibitors, and intra-articular injections such as hyaluronic acid or PRP for early-stage disease. Once medical management fails, surgery moves from joint-preserving options such as high tibial osteotomy and partial knee replacement for one-compartment disease, to total knee, hip, shoulder or elbow replacement once arthritis is diffuse, painful and disabling.

Where robotics is changing outcomes

Dr. Bohra estimates that under manual surgery, 15 to 25 percent of patients ended up functionally well but still unhappy, troubled by mild persistent pain, stiffness or a joint that simply didn't feel natural. Robotic-assisted replacement, guided by real-time sensors and an infrared camera that map the patient's own joint before the robotic arm makes a single cut, is aimed squarely at that gap: more precisely balanced joints across every axis of movement, and a more natural feel that he credits with resolving most of that dissatisfaction.

When cases get complicated

A meaningful share of Dr. Bohra's practice is revision and infection work: implants that failed or became infected elsewhere, periprosthetic fractures after a fall, and neglected cases that arrive after years without treatment, sometimes needing special implants with extension rods and hinge joints. He was direct with the doctors on the call about what this requires: a centre equipped to run a sterile operating environment and manage infection risk down to close to zero, because these are not routine cases.

What the rest of this series covers

The sub-topic articles that follow this guide go deeper into risk factors and clinical diagnosis, non-surgical management, joint-preserving surgery, total replacement, robotics, revision and infection cases, replacement beyond the knee, and the real cost of treatment in India for a patient referred from abroad.