India’s prosthetic care gap is not only a question of technology, infrastructure or affordability. According to Arun Cherian, Founder and CEO of Rise Bionics, one of the biggest missed opportunities happens much earlier in the patient journey: referral.
In a recent post, Cherian highlighted a stark reality. Every year, more than 23,500 amputations are performed in India, yet only a small proportion of amputees ever access prosthetic care. A review of lower-limb amputation rehabilitation in India similarly notes that amputation remains a major cause of disability in the country, while only around 5% of people with amputations have access to prosthetic devices.
The estimate of 23,500 new amputees added each year has also been widely referenced in earlier work on amputees in India, which described the country’s amputee population as predominantly rural, poor, male and of working age. More recent research has also cited the figure of around 23,500 new amputation cases each year in India.
Cherian’s message is direct: 19 out of 20 amputees may not be accessing prosthetic services. For Bharat CPO readers, the key issue is not only the shortage of prosthetic provision. It is the missing connection between amputation surgery and rehabilitation.
In many cases, the clinical pathway after amputation follows a familiar sequence. The surgery is completed successfully. Wound care and infection management follow. The patient is discharged with a walker or wheelchair. Follow-up remains focused on wound healing. But no referral is made to a prosthetist.
The result is that patients return home without knowing what prosthetic rehabilitation could make possible. Weeks turn into months. Muscle atrophy can begin. The ideal window for early assessment and fitting may narrow. Mobility reduces. Dependency increases. For many patients, the psychological impact can be as serious as the physical loss.
This is not a criticism of surgeons. It is a system gap.
Surgeons save lives. Rehabilitation helps people rebuild them. For amputees, that transition requires a coordinated pathway from surgical care to prosthetic assessment, physiotherapy, gait training, stump care, counselling, assistive technology and long-term follow-up.
Cherian argues that prosthetists and surgeons should function as a team, much like oncologists and radiologists do in cancer care. In other words, prosthetic rehabilitation should not depend on whether the patient, family or local doctor happens to know where to ask for help. It should be built into the discharge and follow-up pathway.
This is especially important in India because prosthetists, rehabilitation specialists and advanced prosthetic services remain concentrated in metros and Tier-1 cities. Many amputees, however, live in Tier-2, Tier-3 and rural areas, where awareness, transport, affordability and referral systems can all become barriers.
Accessibility is one wall. Referral is the door.
Opening that door does not always require a new hospital, a new lab or a new funding scheme. It can begin with a standard referral protocol. Every amputation discharge should include information about prosthetic rehabilitation. Every surgical department handling vascular, trauma, orthopaedic, oncology or diabetic limb cases should know where to refer. Every patient should be told that prosthetic assessment may be possible after wound healing and clinical review.
Early referral also helps prosthetists plan better. A patient does not always need to be fitted immediately, but early involvement allows the rehabilitation team to educate the patient, assess the residual limb, advise on positioning and strengthening, prepare for future fitting, and manage expectations.
For diabetic foot and vascular amputees, the need is even greater. These patients may require careful medical coordination, contralateral limb protection, footwear advice, offloading, skin monitoring and long-term rehabilitation planning. A prosthesis alone is not the full solution. But without referral, even that possibility may never be explored.
India already has strong examples of hospital-based prosthetic rehabilitation. Recent reporting from Coimbatore Medical College Hospital described an in-house prosthetic limb manufacturing unit providing free custom-made prosthetic limbs, supported by a multidisciplinary team including orthotists, physiotherapists, occupational therapists and psychiatrists. Such models show what is possible when prosthetic care is connected to hospital systems rather than left to chance.
The next step is to make referral routine.
For hospitals, this could mean adding a prosthetic referral checklist before discharge. For surgeons, it could mean developing direct contact pathways with local prosthetists and rehabilitation providers. For prosthetists, it could mean reaching out to surgical departments and offering simple referral criteria. For policymakers and hospital administrators, it means recognising prosthetic rehabilitation as part of essential post-amputation care.
Cherian’s call is ultimately patient-centred. He is inviting vascular surgeons, general surgeons, orthopaedic surgeons, oncological surgeons, physiatrists, PMR doctors and hospital teams to build referral networks and clinical collaborations.
Not simply for business, but for the patient still sitting in a ward who does not yet know what recovery could look like.
For India’s prosthetic and orthotic sector, this is one of the most urgent opportunities for impact. Technology matters. Cost matters. Manufacturing matters. But before any of those can help, the patient must first be referred.
Early referral means better outcomes. And for thousands of amputees across India, it may be the difference between being discharged to survive and being supported to walk, work and participate again.
Arun Cherian’s LinkedIn post on India’s amputee referral gap
Lower Limb Amputation Rehabilitation Status in India: A Review
Invisible Struggles: Challenges Faced by Women with Amputation in India
Coimbatore hospital helps amputees walk again with free prosthetic limbs