Principal Director & Unit Head, Orthopaedics, Fortis Memorial Research Institute, Gurgaon
Part 2 of 9 in Recent Advances in Joint Replacement
Who Needs a Knee or Hip Replacement: Symptoms and Warning Signs
April 13, 2025
Not every case of joint pain calls for surgery, and Dr. Jangid is direct about what actually separates a patient who needs a replacement from one who does not. The clearest signal is medication dependence: pain that has not responded to treatment, or pain that requires a painkiller every single day. Daily reliance on pain medication is itself a reason to consider surgery, since long-term use of these drugs carries its own risk to the stomach and kidneys.
Physical signs that point to surgery
Beyond pain, Dr. Jangid looks for a cluster of physical signs: visible deformity where the knee bends outward or inward, sound or grinding felt in the joint (crepitus), tenderness to touch, a feeling of instability while walking, and a tendency to fall. He noted that knock knee deformity, where the knees angle inward, is the pattern he sees most often in African patients, more so than the outward bow-leg pattern. Patients also typically describe a growing limitation in ordinary daily activities: walking, climbing stairs, or simply getting around the house.
Why comorbidities and history matter
Joint damage rarely exists in isolation. Dr. Jangid pointed to hypertension and diabetes as common complicating factors, since doctors typically prescribe more walking and activity to manage both conditions, an instruction patients with damaged joints cannot follow. A history of prior trauma that healed poorly is another common route to joint damage over time. He also flagged a detail worth checking in every patient: pain presenting in the knee can sometimes actually originate in the hip or the spine, so those joints should be examined too before assuming the knee itself is the source.
This article is based on a Jivo Masterclass session conducted by Dr. Subhash Jangid, Senior Director, Orthopaedics & Joint Reconstruction, Fortis Memorial Research Institute, Gurgaon. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for an orthopaedic consultation or a second opinion? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Subhash Jangid taught doctors across Africa on April 13, 2025.
FROM THE LIVE Q&A
Dr. Juku
Could the presentation be shared as an English-language PDF?
Dr. Subhash Jangid
Yes, the English PDF was shared again on request.
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Frequently Asked Questions
One attendee thanked Dr. Jangid for the presentation and asked about opportunities to train under him.▼
Doctors from Africa can apply for a one-year fellowship programme in India to learn joint replacement surgery. Interested doctors need to email the team and register with India's National Medical Council before joining for the year-long training.
Is there an age limit for hip or knee replacement surgery?▼
There is no fixed age limit at either end. Hip replacement is generally offered from skeletal maturity onward if the joint is badly damaged, and partial knee replacement is usually done from around age 40, occasionally as early as 30, though most patients present between 45 and 50. Modern implants can last more than 30 years, so age by itself is not the deciding factor.
Could an 80-year-old patient with a knee fracture still be considered a candidate for joint replacement surgery?▼
Yes. Age alone should never be the reason to deny treatment. What matters is whether the patient is physiologically fit and medically able to tolerate surgery, not their chronological age. Every patient deserves the chance to keep leading an active life, fracture or not.
Most post-operative painkillers are known to affect the liver. What pain medication is recommended after joint replacement that avoids this?▼
Opioids are used at a very low dose, delivered through a transdermal skin patch or a nasal spray rather than as tablets or injections, giving good pain control without sedation, headache or nausea. Alongside this, the only oral tablet used is paracetamol, which does not affect the stomach or the kidneys.
Sharing an update: how valuable has attending these weekly sessions been?▼
The attendee said he joins every Sunday and is never disappointed, describing the sessions as consistently insightful and helpful for improving his own practice. He mentioned he had further questions and would send them on separately to be passed along to Dr. Jangid.
Why does needing daily pain medication suggest surgery may be necessary?▼
Needing a painkiller every day, rather than occasionally, points to joint damage that is unlikely to improve on its own, and daily long-term use of these medications carries its own risk to the stomach and kidneys.
Can knee pain actually be coming from a different joint?▼
Yes. Dr. Jangid notes that pain felt in the knee can sometimes originate in the hip or spine, so those areas should be examined alongside the knee itself before deciding on treatment.
In This Series: Recent Advances in Joint Replacement
- 1.Recent Advances in Joint Replacement
- 2.Who Needs a Knee or Hip Replacement: Symptoms and Warning Signs
- 3.Partial or Total Knee Replacement: Matching the Procedure to the Patient
- 4.How Robotic Surgery Is Changing Joint Replacement
- 5.Hip Replacement Surgery: Implant Design, Materials and Durability
- 6.When Joint Replacement Surgery Should Be Delayed or Avoided
- 7.Correcting Severe and Bilateral Knee Deformities
- 8.Recovery, Pain Management and Rehabilitation After Joint Replacement
- 9.Joint Replacement Surgery in India: What International Patients Should Know