Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi
Part 8 of 11 in Diagnosis and Management of Arthritis in Joints
When Arthritis Needs Surgery: Hip, Knee, Shoulder and Elbow Replacement
September 6, 2026
Definitive treatment, in Dr. Mannu Bhatia's framing, only becomes relevant once conservative options, medicine, injections and physiotherapy, have genuinely failed and the patient's daily life is affected. At that point, the joint itself needs to be replaced.
Replacement is matched to the joint involved
If the hip is affected, Dr. Bhatia performs a hip replacement; if the knee, a knee replacement; if the shoulder, a shoulder replacement; and if the elbow, an elbow replacement. Indications across all of these are similar: significant pain, disability, and restricted movement that has not responded to conservative treatment. Done properly, Dr. Bhatia described the success rate as very high.
Knee replacement is a resurfacing procedure, not a swap
Dr. Bhatia was specific about what a knee replacement actually is: despite the name, the knee itself is not replaced. The procedure resurfaces the joint with metal components, while the patient's own bone remains. It is indicated for severely disabled patients, whether the underlying cause is osteoarthritis or rheumatoid arthritis, and in his experience the results are excellent, restoring patients to a point where, in his words, no one can tell they have been operated on at all.
Emerging technology on the horizon
Dr. Bhatia briefly touched on newer developments he considers promising: stem cell therapy, said to help regenerate cartilage, and 3D-printed implants customised to an individual patient's anatomy, which he has already used for some of his own patients. He described this as a large enough topic to warrant its own future session.
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
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?
Dr. Mannu Bhatia
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.
Frequently Asked Questions
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.
Is it possible to do a bilateral hip replacement in a patient with a slipped hip joint?▼
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.
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.
How does a doctor decide which joint to replace?▼
The replacement matches the joint causing the problem: a hip replacement for hip arthritis, a knee replacement for knee arthritis, and similarly for the shoulder or elbow, once conservative treatment has failed and pain or disability persists.
Does knee replacement surgery replace the entire knee?▼
No. Despite the name, the patient's own bone remains; the procedure resurfaces the joint with metal components rather than swapping out the knee itself.
What emerging technologies did Dr. Bhatia mention for joint treatment?▼
Stem cell therapy aimed at regenerating cartilage, and 3D-printed implants customised to an individual patient's anatomy, which he has already used in some of his own cases.
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