India is Facing Knee Arthritis Epidemic: Orthopedic Surgeons

Knee arthritis is emerging as a significant health burden in India. Over 15 crore Indians suffer from knee problems, out of which 4 crore require total knee replacement. In contrast, in China, about 6.5 crore people suffer from knee problems, which is less than half the number in India. Worse, the incidence of knee arthritis among Indians is believed to be up to 15 times higher than that found in Western nations. This is because of the genetic predisposition of Indians towards knee arthritis, and a lifestyle that results in overuse of the knee joints. This was pointed out by senior orthopedic surgeons at a workshop on arthritis at Shalby Hospitals, Jaipur, in the run-up to the World Arthritis Day on October 12.

Speaking at the workshop, Dr. Vikram I Shah, Founder Chairman & Managing Director, Shalby Hospitals, said: "Tremendous advancements have been made in joint replacements in India in the last 20 years, yet the unmet demand remains huge. The country is seeing an arthritis epidemic.

The incidence of knee arthritis in the Indian population is believed to be as much as 15 times higher than what is found in Western nations. USA, with a population of 30 crores, sees 7 lakh knee replacement surgeries every year, but for India, this figure is only 150,000.

While this is a huge jump from a mere 350 knee surgeries that were performed in India in 1994, the unmet demand in the country would be a staggering one crore knee replacements each year, considering the huge size of the population and the propensity of Indians for knee arthritis.

Compared to this, India will be seeing just about one million knee replacements every year by 2022. The good news is that joint replacement surgeries are progressively becoming easier with advancing technology. Today, they involve much lower infection rates and shorter hospital stays."

Dr. Deepak Saini, Sr. Consultant, Arthroplasty & Trauma, Shalby Hospitals, Jaipur, said: "Knee arthritis is expected to emerge as the fourth most common cause of physical disability in India, in a decade or so. It will be difficult for the country to tackle this huge healthcare burden due to the shortage of healthcare infrastructure and orthopedic specialists.

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A major reason for the rapid rise in knee arthritis is that life expectancy in India has doubled since Independence, leading to a huge pool of aging population suffering from wear-and-tear of knees."

Dr. Deepak Saini added: "The most common arthritis in India is age-related degenerative arthritis which involves degeneration (wear and tear) of cartilage, and can affect any joint such as the knee.

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In Indian females, the average age for the onset of knee problems is 50 years, while in Indian males, it is 60 years. The reasons for the early onset of the disease in females include obesity and poor nutrition.

About 90 percent of Indian women are deficient in vitamin D which is a critical component in controlling bone metabolism. Indian traditional lifestyle too affects knee health.

Activities like squatting, sitting cross-legged, use of Indian toilets and not using proper footwear while walking, result in overuse and straining of the knee joint."

Dr. Nishu Gupta, Senior Joint Replacement Surgeon, Shalby Hospitals, Jaipur, said: "Total knee replacement is a very successful procedure which is more than half a century old. It has a 95 percent success rate and has changed the quality of patients' lives dramatically.

Many new developments in knee arthroplasty have been touted in recent years, such as patient-specific instruments, gender-specific knees, minimally invasive surgical techniques and the use of computers to conduct total knee replacements. However, these are much more expensive, and the results have been shown to be no better than ordinary knee replacements.

Nothing can currently replace the experience and skill of the surgeon in achieving a good knee replacement and giving the patient maximum benefit. If patients can choose the right hospital with a skilled surgeon, conventional knee replacement is still the best and most cost-effective option."

Doctors also spoke about the early symptoms of degenerative arthritis, treatment options, and prevention. Said Dr. Ranat R. Vishnoi, Joint Replacement Surgeon, Shalby Hospitals, Jaipur: "Pain and stiffness in any joint of the body as well as noisy joints (joints making repetitive sound) are early symptoms of arthritis. In later stages, there is difficulty in physical movement of joints, and there may also be deformities.

For treating early-stage knee arthritis, medicines like safe analgesics, intra-articular injections and physiotherapy are used. In advanced stages, the most successful treatment is the total knee replacement.

To prevent arthritis, one should avoid squatting, sitting cross-legged, the use of Indian toilets, and standing for long periods of time.

Static quadriceps exercise, cycling, and swimming are the three best exercises for early-stage patients of knee arthritis. The food they eat should also be rich in protein, calcium, and antioxidants derived from dairy products and seasonal fruits and vegetables. To avoid vitamin D deficiency, adequate exposure to sunlight is necessary."

Talking about the arthritis situation in Rajasthan, said Dr. Deepak Saini: "In North West Rajasthan, people have traditionally been using water drawn from the wells. This deep water contains heavy metals and high level of fluoride, which is the biggest cause of joint disease as it results in fluorosis and hardening of bones. For human health, surface water from ponds, rivers, lakes, and streams is the best."

The doctors at the workshop said that the main challenges in treating joint disorders and joint replacements are the financial incapacity of patients and very low awareness among the people about health insurance.

"Though the Ayushmaaan Bharat scheme of the central government has the potential to be a game-changer, reimbursements are not sufficient to cover the cost of good implants. The National Pharmaceutical Pricing Authority (NPPA) has also capped the price of many types of implants. Due to this, foreign manufacturers are hesitant to introduce their latest and best implants in India as the price levels fixed by the government are not matching their expectations," added Dr. Deepak Saini.

The doctors pointed out that while in the Western world, the incidence of hip arthritis in the population is much more than knee arthritis, in India, the situation is the reverse, with only about one hip replacement being done in the country for every 100 knee replacements.

Source-Medindia