For millions of Indians entering their mid-40s and 50s, knee pain begins subtly, a little stiffness while climbing stairs, discomfort while sitting cross-legged, or difficulty squatting. The standard advice is familiar: manage weight, control diabetes, regulate thyroid levels, take supplements, and wait.
According to leading orthopaedic surgeon Dr. Ashwani Maichand, this “wait until it gets worse” approach may be the biggest reason patients eventually land up needing Total Knee Replacement (TKR). “There is a 5–10 year window where the knee can be preserved,” says Dr. Maichand. “Instead of saving the knee, we are often waiting for it to collapse.”
The Four Stages of Arthritis: From Denial to Dead End
Dr. Maichand categorizes knee arthritis into four counselling stages:
Stage 1 – Denial:
Patients dismiss early warning signs. Mild pain is normalized. Even when arthritis is diagnosed, many believe “it’s not that bad.”
Stage 2 – Diversion:
Braces, physiotherapy, glucosamine, collagen, stem cells, and online research. While these may offer temporary relief, they do not address structural damage.
Stage 3 – Desperation:
Climbing stairs becomes difficult. Sitting cross-legged or using an Indian toilet feels impossible. Social life and mobility shrink.
Stage 4 – Dead End:
The knee is severely damaged, often involving the ACL, leaving Total Knee Replacement as the only option.
“This progression is not just the patient’s fault,” Dr. Maichand explains. “Often patients are told it’s ‘not bad enough yet.’ So they wait. By the time they return, crucial structures are already damaged.”
Why the ACL Is the Game-Changer
The Anterior Cruciate Ligament (ACL) is one of the four key ligaments stabilizing the knee. It enables stair climbing, squatting, yoga, and sitting cross-legged. These are movements central to daily life in India.
However, more often than not, knee arthritis often begins with damage to the meniscus, the knee’s natural shock absorber that functions like a ball bearing, reducing friction. When meniscus damage is ignored, it increases stress on the ACL. “The day the ACL is compromised, the journey toward Total Knee Replacement accelerates,” he says.
“It is a modern-day paradox,” he says. “We wait from the time the ACL is healthy to the time it is damaged, and then we replace the whole knee.”
MRI Over X-Ray: Detect Early, Act Early
One of Dr. Maichand’s strongest recommendations is early MRI evaluation instead of relying solely on X-rays. “An X-ray shows bone. It does not show meniscus or ligament damage clearly. If you want to save your ACL, you must check it early,” he advises.
By identifying meniscus damage early, intervention can be planned before irreversible ligament injury occurs.
Rethinking Knee Surgery: Preservation Over Replacement
Dr. Ashwani Maichand highlights that Total Knee Replacement, while effective, is not always the optimal first solution.
- Average TKR lifespan: ~20 years
- Deep flexion limitations in many cases
- Entire joint is replaced
In contrast, meniscus-bearing implant solutions are designed to replicate natural rolling friction. They can preserve the knee’s native structures, including the ACL.
“We are not touching the entire knee. We are replacing the damaged cushion,” he explains. “This can allow patients to sit cross-legged, squat, and maintain culturally important movements.”
He notes that many traditional implants were designed for Western lifestyles, where deep squatting is uncommon. “Orthopaedics must adapt to cultural needs,” he adds.
The Psychosomatic Cost of Waiting
Beyond structural damage, Dr. Maichand warns of the psychological and social toll of declining mobility.
“Inactivity leads to weight gain, poor sleep, and the feeling of ageing prematurely,” he says. “Patients withdraw from travel, social activities, even professional contributions. This is not just a joint problem, it becomes psychosomatic.”
He stresses that many individuals in their 50s and 60s can continue to lead active, productive lives — if intervention is timely.
A Call to Act During the ‘Diversion Stage’
Dr. Maichand’s message is clear:
- Don’t ignore early warning signs.
- Don’t rely solely on supplements or internet advice.
- Don’t wait until climbing stairs becomes impossible.
- Get proper imaging.
- Preserve the ACL.
“Save your knee before it reaches the stage of no return,” he says. “We now have technology and implant options that allow us to intervene earlier and smarter. The goal is not just to remove pain — it is to preserve lifestyle, dignity, and productivity.”
As knee-related ailments continue to rise alongside diabetes and thyroid disorders, Dr. Maichand believes the conversation must shift from reactive replacement to proactive preservation.
“Save your ACL,” he concludes. “You’re not just saving a ligament. You are saving years of active quality life.
