Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi
Part 4 of 11 in Diagnosis and Management of Arthritis in Joints
Recognising Joint Arthritis: Pain, Swelling, Crepitus and Instability
September 6, 2026
The way arthritis feels to a patient changes as the disease progresses, and Dr. Mannu Bhatia laid out that progression clearly during his Jivo Masterclass session.
Pain that changes character
In the early stage, pain is worse with activity and eases with rest. As the disease advances, the pain becomes continuous, present even while the patient is lying in bed or not walking at all. Dr. Bhatia described this constant rest pain as a strong indicator that the patient needs to be seen by a specialist, whether an orthopaedic surgeon or a rheumatologist.
Swelling, warmth and crepitus
Other signs include visible swelling in the joint, warmth to the touch, and crepitus, the grinding or cracking sound produced when the affected bones rub against each other as the patient bends or extends the knee or hip.
Gait, standing and instability
Patients develop difficulty walking, difficulty rising from a chair, and difficulty with prolonged standing or with everyday tasks such as going to the washroom. Range of motion narrows, and the gait itself changes into what Dr. Bhatia described as a waddling, duck-like walk from side to side, a direct consequence of pain and, over time, of the muscle wasting that follows reduced use of the limb. A further, less obvious sign is instability: where a person without arthritis can maintain balance on an uneven surface, a patient with knee arthritis can fall even on a slightly uneven surface.
This article is based on a Jivo Masterclass session conducted by Dr. Mannu Bhatia, Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Mannu Bhatia taught doctors across Africa on February 2, 2025.
FROM THE LIVE Q&A
Moderator
Is it possible to do a bilateral hip replacement in a patient with a slipped hip joint?
Dr. Mannu Bhatia
Bilateral hip replacement can always be done, either in the same sitting or with a gap between the two sides, depending on the patient's condition. If the body can tolerate it, both sides can be done together. If the body, or the finances, don't allow that, there can be a gap in between, but rehabilitation and the expected result need to be planned accordingly.
Frequently Asked Questions
What is the best NSAID to use for osteoarthritis?▼
I would not advise continuous use of NSAIDs, since they can have a harmful effect on the kidneys over time. Short-term use for pain relief is fine.
How affordable are these surgeries at your facility?▼
They are very affordable in India, around half the cost of the same surgery in Nigeria, and much less than the cost in Europe or the US, with better results.
What is the definitive treatment for osteoarthritis?▼
The definitive treatment is that the patient should be visiting the doctor regularly. If the condition is detected and treated at an early stage, that is the definitive treatment. A patient who ignores an ACL injury, skips the recommended MRI, skips the recommended surgery and skips the medicines is the one who progresses to osteoarthritis and eventually needs a knee replacement. Patients with a problem in one knee who don't get it treated often go on to develop the same problem in the other knee, then the hips, then the spine. The definitive treatment is listening to the doctor and following through, whether that means physiotherapy or treatment for rheumatoid arthritis.
I have a patient with intermittent elbow pain, treated with oral and topical NSAIDs followed by PRP injections. What is the outcome of PRP for this patient in Ethiopia?▼
I am not a strong advocate for PRP. Once the joint surface and the cartilage are already gone, PRP cannot regenerate them, so I don't believe it delivers a real result. I would want to see the patient's X-rays, and an MRI if needed, before deciding what should actually be done.
What are the absolute contraindications for joint replacement?▼
As surgical techniques progress, more countries are attempting these surgeries, but two things need to be in place regardless: a genuinely sterile operating theatre, and excellent post-operative facilities, since that is what actually gets the patient the benefit of the surgery. There are no absolute contraindications beyond the patient having a poor overall medical condition, for example a cardiac condition that would make operating on them risky.
What is the difference between early and advanced arthritis pain?▼
Early arthritis pain worsens with activity and eases with rest. In advanced disease, the pain becomes constant, present even at rest, which Dr. Bhatia flags as a sign the patient needs specialist care.
What is crepitus?▼
Crepitus is the grinding or cracking sound produced when the bones of an arthritic joint rub against each other during movement.
Why do arthritis patients fall more easily?▼
Arthritis, particularly in the knee, causes instability. A patient can lose balance and fall even on a slightly uneven surface, something a person with a healthy joint would not experience.
In This Series: Diagnosis and Management of Arthritis in Joints
- 1.Diagnosis and Management of Arthritis in Joints
- 2.What Is Arthritis? Understanding Its Main Types and Causes
- 3.Who Is at Risk of Osteoarthritis: Age, Weight, Occupation and Injury
- 4.Recognising Joint Arthritis: Pain, Swelling, Crepitus and Instability
- 5.Diagnosing Joint Arthritis: Why X-Rays Come Before an MRI
- 6.Non-Surgical Management of Arthritis: Weight, Physiotherapy and Mobility Aids
- 7.Medicines and Joint Injections for Arthritis: What Works and What Doesn't
- 8.When Arthritis Needs Surgery: Hip, Knee, Shoulder and Elbow Replacement
- 9.Recovery After Joint Replacement: Rehabilitation and Activity Limits
- 10.Joint Replacement Case Studies: Patients Who Travelled From Africa for Surgery
- 11.The Cost of Joint Replacement Surgery in India for International Patients