Associate Director, Centre for Orthopaedics, BLK-Max Super Speciality Hospital, New Delhi
Part 6 of 11 in Diagnosis and Management of Arthritis in Joints
Non-Surgical Management of Arthritis: Weight, Physiotherapy and Mobility Aids
September 6, 2026
Before reaching for medication, Dr. Mannu Bhatia starts every arthritis patient on a set of non-pharmacological measures that, in his experience, meaningfully change the course of the disease on their own.
Weight and diet
Patients who are obese carry a materially higher risk of developing joint arthritis, so weight loss is Dr. Bhatia's first recommendation. He pairs it with dietary advice: a diet higher in protein and lower in fat and carbohydrates, avoiding dairy products, confectionery and pastries, while still keeping the overall diet balanced.
Physiotherapy and strengthening
Physical therapy, focused on strengthening the muscles around the affected joint through targeted knee exercises, helps keep the joint balanced even when some degree of arthritis is already present.
Mobility aids to unload the joint
For a patient who is struggling to walk, Dr. Bhatia recommends a walker, cane, or crutch, whatever is needed to unload the joint and let the inflammation settle. He noted this applies even to people who have fallen but do not yet have arthritis: complete rest is not realistic, since patients still need to reach the washroom and manage daily life, so a mobility aid lets them unload the joint while still moving around.
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
How affordable are these surgeries at your facility?
Dr. Mannu Bhatia
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.
Frequently Asked Questions
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.
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.
What is the first line of treatment for arthritis, before medication?▼
Weight loss, dietary changes (more protein, less fat and carbohydrate, avoiding dairy and confectionery), physiotherapy to strengthen the muscles around the joint, and mobility aids such as a walker or cane to unload the joint.
Why does Dr. Bhatia recommend a walker or cane even for patients who don't yet have arthritis?▼
To unload the joint and let inflammation settle, while still allowing the patient to manage daily activities like reaching the washroom, rather than attempting complete bed rest.
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