Diagnosis & Management of Degenerative Joint Disease
Senior Director, Joint Replacement Programme
BLK-Max Super Speciality Hospital, New Delhi
April 27, 2025
Dr. Ishwar Bohra, Senior Director of the Joint Replacement Programme at BLK-Max Super Speciality Hospital, New Delhi, walks doctors from across Africa through the diagnosis and staged management of degenerative joint disease, from early lifestyle and medical therapy through joint-preserving surgery to total knee, hip, shoulder and elbow replacement. Drawing on more than two decades of practice, he explains how robotic-assisted surgery is closing the satisfaction gap seen with manual replacement, and shares a series of complex revision and infection cases from his own operating theatre.
Questions Doctors Asked Dr. Ishwar Bohra
Real questions from the live masterclass, answered by Dr. Ishwar Bohra, Senior Director, Joint Replacement Programme.
Is there a relationship between vitamin D deficiency and osteoarthritis?
Asked by Dr. Kobel
Definitely, because vitamin D is essential in bone metabolism: it regulates the calcium, magnesium and phosphorus that are the key minerals of bone strength. If vitamin D is low, the subchondral bone that gives cartilage its strength becomes weak, so the cartilage starts to wear and the bone becomes soft and malaligned, which leads to arthritis. This is a major contributory factor that often isn't picked up clinically, so once a patient is diagnosed with hypovitaminosis D, it should be corrected immediately to avoid future complications.
Answered by Dr. Ishwar Bohra
Is total knee replacement indicated for children with juvenile idiopathic arthritis?
Asked by Dr. Destin
Hip replacement can be done even after 13 to 14 years of age, but knee replacement has to wait until 18, because the longevity of implants in children is not very good and outcomes are worse than with hip replacement. If a child is severely affected, knee replacement can be considered after age 16 to 18; before that, an alternative non-replacement approach, such as bracing, is used to manage the pain.
Answered by Dr. Ishwar Bohra
Is there any risk of malignant transformation in a patient with a malunited tibia fracture of more than 10 years' duration without treatment?
Asked by Dr. Olimei
No, a malunited fracture carries no risk of malignant transformation.
Answered by Dr. Ishwar Bohra
What is the total cost of doing a total knee replacement, in dollars?
Asked by Dr. Olimei
Approximate cost in my own practice runs around 7,000 to 7,500 US dollars, depending on the patient's room selection and other choices. India, and our hospital specifically, offers one of the most subsidised rates in the world compared with the West and the rest of Asia.
Answered by Dr. Ishwar Bohra