Evolving organisational models in urban orthopaedic practice in India: A structured narrative review.

Abstract

Urban orthopaedic practice in India is undergoing profound organisational change driven by population ageing, an increasing burden of musculoskeletal disease, expanding subspecialisation, technological advances, and growing regulatory and quality-reporting requirements. These developments have renewed interest in organisational models capable of supporting coordinated, high-quality musculoskeletal care while maintaining clinical efficiency and professional sustainability. This structured narrative review evaluates contemporary organisational models of orthopaedic practice, with particular emphasis on structured group practice, within the Indian healthcare context. A structured narrative review was undertaken using PubMed as the primary database, supplemented by targeted Google Scholar searches and manual reference screening. Forty-five publications meeting predefined eligibility criteria were included in the final narrative synthesis. Evidence relating to orthopaedic practice organisation, subspecialisation, volume-outcome relationships, multidisciplinary care, clinical governance, registry participation, workforce wellbeing, health-system organisation, and practice sustainability was synthesised. The available literature suggests that structured group practice may facilitate subspecialty-focused care, multidisciplinary collaboration, standardisation of perioperative pathways, registry participation, continuous quality improvement, and equitable workload distribution. However, direct comparative evidence demonstrating superiority over well-organised solo or small-group practice remains limited, particularly in India. Many reported advantages appear to arise from effective evidence-based organisational processes rather than organisational size alone. The available evidence suggests that organisational models capable of supporting multidisciplinary care, clinical governance, and evidence-based organisational processes are increasingly important for contemporary orthopaedic practice. Structured group practice represents one context-dependent organisational approach that may be particularly relevant to urban India. The review identifies important evidence gaps, particularly the lack of comparative Indian studies, and highlights priorities for future research.