To investigate the cost-effectiveness of using an innovative gradually reducing femoral radius design implant (GRAD) vs. a class of metal-backed implants (SOC) for patients with osteoarthritis who require a total knee arthroplasty (TKA) in both the public and private sectors in India. A Markov model was developed to compare the costs and outcomes of using GRAD vs. SOC over a 10-year time horizon in both the public and private sectors in India. The health states included were full benefit after primary TKA, limited benefit after primary TKA, primary TKA failure, full benefit after revision TKA, limited benefit after revision TKA and failure of revision TKA. The model assessed both direct and indirect costs such as cost of implant, surgery, hospitalisation, follow-up visits and productivity loss. One-way sensitivity analysis and probabilistic sensitivity analysis tested the robustness of the base case incremental cost-effectiveness ratio. Provisional results show that after 10 years the expected difference in the total cost of using GRAD vs a SOC per patient is (-₹4,170 or -₹7,224) in the public and private sectors respectively. The increment in quality-adjusted life years (QALYs) per patient is (0.0072 or 0.0068) for the public and private sectors respectively. Therefore using the innovative design implant is the economically dominant strategy as it produces more QALYs at a lower cost than SOC. The model results were most sensitive to the cost of the surgery, the probability of knee survivorship, and the discount rates. Provisional results indicate that using the innovative gradually reducing femoral radius design implant in Indian patients undergoing a TKA is cost-effective in both the public and private sectors compared to class of metal-backed implants and is therefore likely to result in better allocation of resources for the Indian healthcare system.