Joint replacement surgeries are becoming increasingly common in India, with demand rising rapidly alongside improving healthcare access ^[1,2]. Patients needing procedures such as total knee or hip arthroplasty often face a complex decision when selecting their surgeon. Multiple factors – both clinical and personal – influence this choice. This editorial examines key factors that Indian patients consider when choosing a joint replacement surgeon, including experience and reputation, hospital infrastructure, cost considerations, referrals and online information, regional differences, and evolving patient expectations. Each dimension plays a role in shaping patient preferences, as evidenced by recent studies, and understanding these can help improve patient-centered care. India is projected to have one of the fastest growth rates globally in joint arthroplasty volume ^[3], underscoring the urgency of understanding patient decision factors.

The experience and reputation of the surgeon are consistently top priorities for patients. Indian patients strongly prefer surgeons with extensive experience – one survey found 59% of respondents favored surgeons with over 20 years of experience ^[4]. Surgical track record and outcomes build a surgeon’s reputation, which heavily influences patient trust. In an Indian study on ideal surgeon attributes, patients most frequently ranked years of experience and surgical outcomes among their top criteria ^[5]. A surgeon’s professional reputation – often reflected by credentials and past success – similarly carries great weight. For example, in a U.S. Medicare population, patients cited surgeon reputation and operative experience as major factors in their choice ^[6]. Board certification and specialized training further bolster reputation; a 2024 survey reported that patients rated a surgeon’s board certification and fellowship training as very important factors when selecting an arthroplasty surgeon ^[7]. These findings underscore that Indian patients, like those elsewhere, seek seasoned surgeons with proven expertise and standing in the field. It may be valuable to mention that this patient preference aligns with clinical evidence: higher-volume or more experienced surgeons tend to have lower complication and revision rates, contributing to better outcomes ^[8].

The quality of the hospital and availability of advanced technology also influence surgeon selection. Patients tend to associate a surgeon with their hospital’s infrastructure, surgical facilities, and equipment. A well-equipped hospital with modern operation theaters, stringent infection control, and advanced technology (such as robotic surgery systems) can attract patients aiming for the best care. Hospital reputation and facility quality were identified as key considerations in surgeon choice in qualitative research ^[6]. In India, many patients now value surgeons who can offer state-of-the-art techniques – over 73% of patients in one survey preferred surgeons skilled in robotic joint replacement surgery using robotic systems such as MISSO, CUVIS, MAKO, and ROSA ^[4]. The reasoning is that cutting-edge technology may improve precision and outcomes, reflecting a hospital’s commitment to high-quality care. In addition, patients notice seemingly basic infrastructure elements: for instance, facility appearance and cleanliness were rated important by arthroplasty patients (mean importance score 4.26/5 in one study) ^[7]. Especially in urban centers, private hospitals often market their superior infrastructure, which can reinforce a surgeon’s appeal. Overall, a surgeon practicing at an accredited, well-resourced hospital with modern technology provides patients extra confidence in the safety and success of the procedure. While patients equate advanced technology (e.g., robotic surgery) with better outcomes ^[9], studies have shown that patients define “value” more by outcomes than by cost. One analysis found that improved clinical outcomes (e.g., better function after surgery) increased patient satisfaction, whereas lower cost alone did not significantly raise perceived value ^[10]. This implies that when finances allow, patients will pay more for a surgeon or hospital if they believe it leads to superior results.

Financial considerations significantly affect surgeon choice in India, where many patients pay out-of-pocket for elective surgery. The cost of joint replacement can be substantial, and patients must balance trust in a surgeon with affordability. Indeed, 63.8% of Indian patients surveyed cited financial considerations as affecting their choice ^[4]. Patients may compare surgeons’ fees and hospital charges or check if the surgery is covered by their insurance or government health schemes. Insurance coverage is a growing factor – for example, one study found “in-network” insurance status of the surgeon was among the top factors for patients choosing a provider ^[7]. In India, public health programs have begun to cover joint replacements (e.g., under the Ayushman Bharat scheme, a standardized package for total knee replacement is around 55,000–1,00,000), which enables many patients to consider reputable surgeons they might otherwise not afford ^[11]. Cost disparities between public and private hospitals are notable: A 2021 audit reported the average cost of a primary knee replacement in a government hospital was 85,927–only ~39% of the cost in a private hospital (217,667) for the same procedure ^[12]. Such differences mean cost can sometimes override other preferences, especially for uninsured patients. However, when patients do have means or coverage, they prioritize quality over price. Notably, research from consumer-driven markets found that despite the availability of cost information, patients rarely choose surgeons based on the lowest cost, focusing more on surgeon reputation ^[13]. In summary, cost and insurance factors are vital in India’s context but are carefully weighed alongside perceived quality – affordable care is desired, yet patients are cautious about compromising on the surgeon’s expertise and outcomes.

Personal recommendations and information from the media also shape patients’ surgeon choices. Word-of-mouth referrals remain the strongest influence. Many Indian patients rely on their primary doctors, friends, or family for advice on which surgeon to consult. In a qualitative study, patients overwhelmingly cited referral by another physician as the top reason for choosing a particular joint replacement surgeon ^[6]. Likewise, in an Indian survey, family or friend recommendations were reported by 33.8% of patients as a primary factor, second only to surgeon reputation ^[4]. These trusted endorsements carry weight because they come from firsthand experiences. In contrast, the influence of the Internet and social media, while rising, is still evolving. Patients increasingly read online reviews on doctor-rating platforms or hospital websites. Studies of online ratings of joint replacement surgeons show the majority of patients post-positive reviews (average rating ~4.3/5) and that truly negative reviews are relatively rare ^[14]. When negative comments occur, they often pertain to a surgeon’s bedside manner, communication, wait times, or outcomes rather than clinical incompetence ^[14]. Such reviews can sway perceptions for tech-savvy patients, especially if multiple people report similar issues. However, the overall impact of social media and advertising remains limited. In a 2024 patient survey, traditional advertisements (TV, print, and online) and a surgeon’s social media presence were rated among the least important factors in choosing an arthroplasty surgeon ^[7]. Only about 17% of Indian patients in one study said online platforms significantly affected their decision ^[4]. To further optimize their chances of being chosen as the preferred healthcare provider, joint replacement surgeons must not only demonstrate surgical expertise but also actively engage in building trust, accessibility, and visibility among patients. Establishing transparent communication, participating in public education, and maintaining a strong reputation in both professional and social domains can significantly enhance a surgeon’s appeal. In this process, the role of industry becomes highly relevant. Partnerships between surgeons and healthcare companies extend beyond technology and implants to initiatives that empower both decision makers (patients) and healthcare providers (doctors and hospitals).

A notable example is Meril’s “Treatment Zaroori Hai” campaign, which leverages trusted public figures such as Mahendra Singh Dhoni to generate patient confidence in joint replacement as a safe and necessary treatment. Under the same initiative, Meril has undertaken awareness drives through newspapers, radio, and social media, helping patients understand disease progression, treatment options, and the importance of early consultation. These efforts strengthen the perception of surgeons as accessible, credible professionals aligned with patients’ needs.

Other orthopedic companies have adopted similar strategies. Johnson and Johnson India has launched the “Heal with Mobility” awareness campaign, focusing on educating patients about arthritis and the benefits of timely joint replacement. Zimmer Biomet has supported community outreach programs and patient seminars across Indian metros, aimed at improving public understanding of robotic-assisted surgery. Stryker, through its “GetAroundKnee” initiative, has combined digital platforms and patient testimonials to build confidence in advanced knee replacement solutions. Collectively, these campaigns not only promote brand awareness but also indirectly position surgeons as trusted providers by increasing patient literacy and reducing stigma around joint replacement.

Furthermore, industry-led print and social media support amplifies surgeon visibility in an increasingly digital healthcare landscape. By supporting branding, outreach, and public education campaigns, companies contribute to strengthening the surgeon–patient connection and reinforcing hospitals as trusted centers of excellence. These examples highlight that when industry and surgeons work in tandem, the result is improved patient trust, greater healthcare literacy, and more informed decision-making, ultimately benefiting both patients and providers.

Thus, while a good online reputation and digital engagement can enhance a surgeon’s visibility, most Indian patients still place greater trust in direct referrals and personal recommendations when making their final choice.

Geography and demographics in India create differing patient priorities. In urban areas, patients typically have access to multiple specialist surgeons and advanced hospitals; they may be more aware of options and emphasize factors such as technology and reputation. Rural patients often face limited local expertise, leading many to travel long distances for a reputed surgeon or better facility. In fact, willingness to travel is notable – about 63.8% of surveyed Indian patients were willing to go out-of-state to consult a renowned joint replacement expert ^[4]. This indicates that geographical distance is becoming less of a barrier for those who can afford travel, as patients from smaller towns increasingly seek care in metropolitan “centers of excellence.” The urban–rural divide also affects information sources: Urban, educated patients may utilize online research and seek second opinions, whereas rural patients more often depend on referral by a local doctor or public hospital system. Demographics such as age and socioeconomic status further modulate choices. Elderly patients or those from rural backgrounds might prioritize trust and proximity, whereas younger, more educated patients might value hospital quality and peer reviews. Nonetheless, studies suggest a converging trend where regional differences are narrowing – many patients, regardless of origin, now converge upon high-volume urban institutions for joint replacement, given the higher perceived quality of care ^[4]. This centralization means that top surgeons in cities draw diverse patients nationally. Recognizing these patterns, some state governments and private providers are working to improve rural access (e.g., satellite clinics and tele-consultations) so that initial evaluations can be done locally before referral. In summary, urban patients benefit from choice and information, whereas rural patients exhibit remarkable willingness to travel for the best surgeon, reflecting a shared high value placed on quality of care across regions.

Patients in India today have higher expectations than ever from their joint replacement surgeries and the surgeons who perform them. Increased health awareness, education, and exposure to global medical advances have empowered patients to demand more personalized and high-quality care ^[15]. Recent research explicitly notes a “significant rise in patient expectations” among Indian joint replacement candidates ^[4]. Patients not only expect relief from pain and restoration of mobility, but also a smooth recovery, compassionate communication, and transparency throughout the process. They anticipate that surgeons will involve them in decision-making and inform them about implant choices, risks, and rehabilitation. This trend is part of a broader shift toward patient-centric care. Studies have linked the fulfillment of patient expectations to better satisfaction after surgery, underscoring why surgeons must manage expectations realistically and meet them whenever possible ^[4]. In addition, today’s patients often compare their outcomes and experiences with others (through social networks or patient communities), raising the bar for what is considered a “successful” joint replacement. They are less willing to tolerate poor service quality or unanswered concerns. As a result, surgeons in India are adapting – many now spend more time on pre-operative counseling and setting realistic outcome goals, as well as adopting newer techniques to meet expectations for less pain and faster recovery. By 2030, the demand for knee replacements in India is projected to soar by over 600% ^[2], and with this surge comes a parallel increase in patient expectations around outcomes and overall experience. Chrenka et al. demonstrated that better shared decision-making before surgery is associated with modestly higher post-operative functional scores and a greater likelihood that patients will recommend their surgeon ^[16]. Similarly, a prospective study in Asia found that fulfillment of pre-operative expectations was strongly correlated with improved pain relief, functional gains, and overall satisfaction at 1 year after knee arthroplasty ^[17]. These data concretely show that patient expectations are not just a “feel-good” aspect but influence measurable outcomes and satisfaction. Conversely, a gap between expected and actual results can lead to disappointment even if the clinical outcome is objectively good. Therefore, surgeons must recognize that, along with surgical skill, meeting patients’ expectations – through clear communication, empathy, and high-quality service – is key to maintaining their reputation in this era of empowered patients.

Choosing a joint replacement surgeon is a multifaceted decision for patients, especially in a diverse healthcare landscape like India’s. Patients weigh the surgeon’s experience, reputation, and qualifications heavily, while also considering the supporting hospital facilities and technologies available. Financial factors – cost of surgery and insurance coverage – can enable or limit options, although many patients strive to choose quality over price if given a choice. Referrals from trusted doctors and peers remain invaluable in guiding patients, even as online reviews and social media play a growing secondary role. Urban–rural disparities persist in access to expert surgeons, yet patients are increasingly willing to travel to obtain the best care. Rising expectations further emphasize the importance of transparency, patient-centered communication, and empathetic care.

Beyond individual surgeon efforts, the role of industry in shaping patient preferences is becoming increasingly significant. Campaigns such as Meril’s “Treatment Zaroori Hai” and other initiatives demonstrate how awareness programs, media outreach, and trusted public figures can reduce stigma, improve healthcare literacy, and empower patients to make informed choices. By providing platforms for education and visibility, industry partners help both decision makers (patients) and providers (surgeons and hospitals) align around shared goals of trust, accessibility, and better outcomes. This integrated approach can improve satisfaction, optimize outcomes, and build long-term trust between patients and providers.

Surgeons must recognize that patient trust hinges not only on surgical skill but also on communication, affordability, and alignment with patient expectations. Integrating these priorities into practice can improve satisfaction and outcomes in India’s growing arthroplasty landscape.