Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi
Series overview · 11 articles
Diagnosis and Management of Arthritis in Joints
September 6, 2026
Dr. Mannu Bhatia, Associate Director, Centre for Orthopaedics at BLK-Max Super Speciality Hospital, New Delhi, used a Jivo Masterclass session to walk through arthritis of the joints from first principles: what actually happens inside a joint when arthritis sets in, how it is diagnosed, when medicine and physiotherapy are enough, and when replacement surgery becomes the right answer. He illustrated the discussion with cases of patients from Cameroon, Ethiopia, Gambia and Yemen who travelled to him for hip, knee and elbow surgery.
A joint problem that looks different in different regions
Dr. Bhatia's own patient mix illustrates how arthritis presents differently by region. Among ten arthritis patients he sees in India, roughly nine have knee arthritis; among patients he sees from Africa, the pattern reverses, with around eight of ten presenting with hip arthritis and only one or two with knee involvement.
From cartilage breakdown to a joint replacement decision
Every case in the session followed the same underlying logic. A joint stays healthy as long as its cartilage is intact; once cartilage starts to break down, whether from age, injury, autoimmune disease or another cause, arthritis begins. Diagnosis leans on X-rays first, reserving MRI for patients whose X-ray looks normal but whose symptoms persist. Treatment then follows a ladder: weight loss, diet and physiotherapy first, medicines and joint injections next, and hip, knee, shoulder or elbow replacement only once conservative options have failed and the patient's daily life is genuinely affected.
What this series covers
This series draws on Dr. Bhatia's Jivo Masterclass session to look at each part of that logic in turn: the main types and causes of arthritis, who is most at risk, how to recognise its clinical signs, how it is diagnosed, non-surgical management, medicines and injections including where platelet-rich plasma falls short, joint replacement surgery itself, recovery and rehabilitation afterward, real patient cases from across Africa, and the cost of surgery in India for international patients.
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
Dr. Sunday
What is the definitive treatment for osteoarthritis?
Dr. Mannu Bhatia
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.
Frequently Asked Questions
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.
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 does Dr. Mannu Bhatia's Jivo Masterclass session cover?▼
It covers the main types and causes of joint arthritis, risk factors, clinical signs, diagnosis by X-ray and MRI, non-surgical management, medicines and injections, joint replacement surgery for the hip, knee, shoulder and elbow, recovery and rehabilitation, and the cost of treatment in India for international patients.
Where does Dr. Mannu Bhatia practise?▼
Dr. Mannu Bhatia is Associate Director, Centre for Orthopaedics at BLK-Max Super Speciality Hospital, New Delhi.
How does Dr. Bhatia decide whether a patient needs joint replacement surgery?▼
He starts with an X-ray, which he considers the most informative test for arthritis, and moves to an MRI only if the X-ray looks normal but the patient's symptoms continue despite medication and physiotherapy. Replacement surgery is reserved for patients whose conservative treatment has failed and whose daily life is genuinely affected.
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