Do you have old parents tired of joint pain? Robotic joint replacement would have been the answer, but limited insurance coverage is the biggest barrier.

For many Indians suffering from severe knee and hip arthritis, getting a joint replacement surgery is often seen as the path back to mobility and independence. But doctors now say a growing number of patients are discovering that having health insurance does not necessarily mean access to newer robotic-assisted surgeries.

Orthopaedic specialists and patient advocates say insurance restrictions and reimbursement caps are major barriers preventing patients from opting for advanced robotic surgeries.

Partnership to Fight Chronic Disease (PFCD) has also raised concerns over widening gaps in insurance coverage for advanced joint replacement procedures.

India performs an estimated 2.5 lakh to 3.5 lakh joint replacement surgeries every year. However, robotic-assisted procedures account for only around 5-10% of these surgeries, with adoption largely limited to metro hospitals that have access to robotic systems and trained specialists.

Doctors say robotic surgery can help improve surgical precision through CT-based planning that allows procedures to be tailored to a patient’s anatomy. They say the technology may help improve implant alignment, preserve healthy tissue and potentially improve long-term outcomes.

But patients often face a financial shock when insurers either partially cover robotic procedures, impose sub-limits, or in some cases reimburse them at lower levels than conventional joint replacement surgeries.

In many standard health insurance policies, hospitalisation expenses for conventional knee or hip replacement surgeries are covered, but newer technologies such as robotic-assisted procedures may fall into grey areas depending on the insurer, policy wording, package rates and hospital agreements. Industry executives say some insurers classify the robotic component as an additional technology cost rather than an essential medical expense, leaving patients to pay the difference out of pocket.

Patients are often forced to make treatment choices based on insurance coverage rather than clinical need, according to doctors working in the field.

Dr. Ramneek Mahajan, Chairman – Orthopaedics, Joint Replacement and Chief Robotic Joint Replacement at Max Healthcare, said robotic-assisted joint replacement allows surgeons to perform procedures with greater accuracy and consistency.

“However, when insurance policies place restrictions on modern surgical techniques, patients are often compelled to choose conventional procedures even when more precise options are available,” he said.

Dr. Havind Tandon, Senior Consultant, Orthopaedics and Joint Replacement at Apollo Hospital, said insurance limitations are affecting patient decisions in real-world clinical settings.

“Many patients are willing to consider advanced surgical options for better recovery and mobility, but sub-limits and reimbursement restrictions create financial uncertainty,” he said. “As a result, patients may settle for alternatives that align with insurance coverage rather than what is clinically most suitable.”

The issue has gained attention despite the Insurance Regulatory and Development Authority of India (IRDAI) issuing guidelines in 2019 asking insurers to include modern treatments, including robotic surgeries, subject to policy terms and conditions. Doctors say implementation remains uneven, with reimbursement limits varying widely across insurers and corporate health plans. Some insurers still treat robotic technology as an optional or luxury component rather than a medically relevant advancement.

Dr. Subhash Jhangid, Director and Head, Joint Replacement and Orthopaedics at Fortis Memorial Research Institute, said insurers should also evaluate the long-term healthcare impact of robotic-assisted procedures.

“Robotic-assisted joint replacement can contribute to better implant positioning, fewer complications, and a lower likelihood of revision surgeries,” he said. “When insurers look beyond the upfront cost of technology and evaluate the overall impact on patient outcomes and long-term healthcare expenditure, comprehensive coverage can prove beneficial for both patients and the healthcare system.”

The issue is becoming more significant as arthritis and mobility-related conditions rise among India’s ageing population. Doctors say delayed surgeries or compromises in treatment can affect mobility, independence and long-term quality of life for patients.

Aman Gupta said wider insurance support for robotic-assisted surgeries is necessary to improve access to advanced treatment options.

“We advocate for insurance policies that recognise robotic joint replacement as a medically necessary, value-driven innovation,” he said. “Bridging these insurance gaps is essential for enabling equitable access to world-class care.”