Osteoarthritis (OA) is the most common arthritic disease and is a major cause of disability worldwide. It has a prevalence of 22% to 39% in India. OA is more common in women than men and its prevalence increases with age. Nearly, 45% of women over the age of 50 years have symptoms while 70% of those over 55 years show radiological evidence of OA. And, with India’s elderly population set to increase by nearly 41% in 2031 from around 138 million in 2021, according to the National Statistical Office report, the burden of the disease is further expected to increase.
In an exclusive interaction with OnlyMyHealth editorial team Dr Gottemukkala Ashok Raju, Head & Senior Consultant of Orthopaedic Surgery, Citizens Specialty Hospital, Hyderabad explains what Osteoarthritis is and the need for orthopaedic speciality treatment in India. Here is what he shared with us.
Medical management of Osteoarthritis
OA commonly affects the knee joint, but it can also affect the hips, hand, shoulder, and spine, causing significant movement disability. Medical management of OA generally includes weight reduction, physiotherapy and pharmacotherapy, however, these interventions have only modest and temporary benefits. Surgical intervention in the form of joint replacement surgeries is usually the last resort but such surgeries can also have a physical and psychosocial impact, besides placing a tremendous economic burden on the family as well as on the healthcare resources of the country. Thus, there is a need for reforms in the orthopaedics speciality.
Treatment of Osteoarthritis
In emerging countries like India, where we already have a limited healthcare budget, the foremost challenge is to provide a minimum standard of orthopaedic care to all. Moreover, the poor surgeon-patient ratio too contributes to the grim state of the health sector. According to the available data, we have approximately 20,000 orthopaedic surgeons available to cater to about 1.25 billion people, i.e. one surgeon to 62,500 population.
Moreover, the surgeons are primarily concentrated in metropolitans and big cities, which further makes things worse for the rural population. The medical solutions and reforms have to be based on the following analysis:
Due to limited infrastructure and scarcity of hospital settings, the patients in rural or even uncharted areas are unable to get primary care in an emergency situation. Ironically, people in rural and tribal areas are more prone to develop OA owing to their poor diet and lack of awareness. The diagnosis is also delayed, hence by the time they seek or get treatment, the case is already complicated, especially in the case of trauma victims.
Making Implants Affordable
In India, there is a price cap by the National Pharmaceutical Pricing Authority (NPPA) on total knee replacement implants. It is aimed at increasing the affordability and accessibility of advanced treatments for the economically weaker strata to for a better quality of life. Though overall procedure costs are still unaffordable for the majority.
Enforcement of Standards
Although we have Medical Devices Rules (2016), it is still crucial to reinforce the implementation of certain regulatory standards to curb the unorganised sector in implants. Such companies produce substandard products by keeping costs low and compete purely on the price factor, with no thoughts given to product quality and patient safety. Thus, to enable a fairer market for domestic manufacturers and promote ‘made in India’ products.
In the light of the above inadequacies and challenges, it is important to collaborate and play an active role in defining the orthopaedic needs of the nation, only then will we be able to provide optimum orthopaedic care to all.