India’s ageing transition is making the preservation of mobility an increasingly important public-health concern. The population aged 60 and above is projected to exceed 20 percent by 2050. The Longitudinal Ageing Study in India, conducted by the Ministry of Health and Family Welfare, shows that 23.8 percent of older Indians reported at least one limitation in activities of daily living, including walking across a room and getting in or out of bed. Osteoarthritis adds substantially to this burden: an estimated 62.35 million people in India were living with the condition in 2019, with the knee the most commonly affected joint.
For people with knee osteoarthritis, the consequences extend well beyond pain. Difficulty walking, climbing stairs or rising from a chair can restrict work, caregiving, access to services and participation in everyday life. Effective care may require primary care, physiotherapy and rehabilitation, pain management, specialist orthopaedics and, for some patients, joint replacement. The policy question is therefore not simply whether these services exist, but whether patients can move through them at the right time, with preservation and restoration of mobility as the outcome.
Knee osteoarthritis is therefore a useful test of India’s approach to healthy ageing: whether the health system can identify functional decline early, provide effective non-surgical care and rehabilitation, enable timely specialist intervention, and support recovery when surgery is appropriate.
India Has the Pieces, but Not Yet the Pathway
India is not starting from a policy vacuum. The National Programme for Health Care of the Elderly (NPHCE), launched in 2011, was designed to provide preventive, curative and rehabilitative care across primary, secondary and tertiary facilities, including physiotherapy, home-based care and referral services. Its footprint has expanded substantially: by 2020–21, geriatric outpatient services were reported at 584 district hospitals, 3,111 community health centres and 10,180 primary health centres, while physiotherapy services were available at 445 district hospitals and 1,131 community health centres.
India also has a Standard Treatment Guideline for osteoarthritis that places exercise, weight management, patient education and other non-pharmacological measures within routine care, with specialist referral and surgery for appropriate cases. The policy architecture therefore recognises many of the components needed to protect mobility in later life. The issue is whether patients can move reliably between them.
Reviews of NPHCE implementation have found substantial variation across states, including shortages of trained personnel and equipment, gaps in service delivery and weak referral linkages; some facilities were reported to be only partly functional. Evidence from knee osteoarthritis illustrates what discontinuity can look like. In a multicentre Indian study of patients attending specialist orthopaedic clinics, 81.9 percent had previously received some form of non-pharmacological treatment, but only 55.2 percent had seen a physiotherapist. Patients at government hospitals also reported longer periods of knee pain before presentation than those attending private hospitals.
Continuity after surgery matters as well. A Delhi study found that more than half of patients sought physiotherapy after knee replacement. The median cost of rehabilitation was ₹18,395, while only 26 percent could recall all their discharge instructions. These findings do not describe every patient’s experience, but they point to potential weaknesses at the transitions between treatment, rehabilitation and recovery.
The gap, then, is not simply the availability of individual services, but the absence of a consistently connected pathway between them. Patients can still be left to navigate transitions between primary care, rehabilitation and specialist treatment themselves. What is missing is an explicit system-level focus on whether mobility has been preserved or restored at each stage of care.
Making Mobility the Outcome
The policy response should begin by making functional decline visible earlier in the care pathway. Primary care should assess symptoms alongside mobility, muscle strength, weight, comorbidities and the effect of pain on daily activities; an X-ray alone cannot determine the care a patient needs. Routine functional assessment could help identify patients who need early support and provide a clearer basis for subsequent treatment and referral.
Early identification must also lead to accessible non-surgical care. Counselling on exercise, weight management and pain control can help patients maintain function, while clear guidance can reduce reliance on unproven treatments marketed as cartilage-regenerating cures. Physiotherapy and rehabilitation should be accessible early and remain available as needs change, rather than being treated as optional additions after symptoms become severe or surgery has occurred. Rehabilitation is also recognised by WHO as an essential component of universal health coverage.
The next requirement is a clearer connection between non-surgical and specialist care. Referral pathways should specify when persistent pain, declining function or failure of appropriate non-surgical treatment warrants specialist assessment. Joint replacement should be considered in the context of symptoms, functional loss and response to reasonable non-surgical treatment, rather than imaging findings alone. Equally, repeatedly postponing appropriate surgery in a patient with severe pain, major functional limitation and failure of such treatment can prolong disability.
Where surgery is appropriate, the pathway should extend through recovery. Joint replacement should form part of a wider process that includes pre-operative optimisation, peri-operative safety, physiotherapy, home support and follow-up. Success should be judged not simply by whether a procedure was completed, but by whether the patient regained function and independence. The same standard should apply to new technologies, including robotic assistance: their value should be assessed through improvements in pain, function and recovery rather than assumed to substitute for clinical judgement or continuity of care.
India already has much of the institutional architecture needed to respond. The next step is not simply to add more individual services, but to connect existing ones around a common objective: preserving and restoring mobility. That requires functional decline to be identified early, patients to move through appropriate care without avoidable delays, and recovery to be followed beyond the intervention itself. For an ageing India, the ability to move independently is not merely an orthopaedic outcome. It is a measure of healthy ageing itself – and should become an explicit outcome of the health system.