A Joint Registry For The U.S

January 11, 2011

In 2002 England and Wales created the first National Joint Registry. According to their website, its purpose is to define, improve and maintain the quality of care of individuals receiving hip, knee and ankle joint replacement surgery across the NHS and the independent healthcare sector. In their words,  the Registry helps to monitor the performance of these implants and the effectiveness of different types of surgery, improving clinical standards and benefiting patients, clinicians and the orthopaedic industry.

Joint registries also exist in Australia, Canada, Sweden, Finland, Norway, Denmark, and New Zealand. Many have more than 10 years of experience and are currently collecting data (including but not limited to the date of surgery, type of implant, operating surgeon, patient’s name, date of birth, social security number, and sex), on more than 90 percent of procedures nationally.

So will the U.S ever have our own registry and if so, where are we in the process?

The American Academy of Orthopaedic Surgeons (AAOS) is actively engaged in creating an U.S. joint registry and in June 2009, the American Joint Replacement Registry (AJRR) was incorporated in Illinois.

“We’re on the verge of making a U.S. joint replacement registry a reality,” said David G. Lewallen, MD, chair of the American Joint Replacement Registry (AJRR) board of directors, during an educational session held during the AAOS 2010 Annual Meeting.The mission of the AJRR is to foster a national center for data collection and research on total hip and knee replacement that has “far-reaching benefits to society, including reduced morbidity and mortality; improved patient safety, quality of care, and medical decision-making; reduced medical spending; and advances in orthopaedic science and bioengineering,” said Dr. Lewallen.

  • In 2006, there were more than 1 million hip and knee replacements in the U.S Of these, approximately 7.5% were revisions, resulting in 77,000procedures at a cost of more than $3.2 billion.
  • Registries in Sweden, Great Britain, Canada and Australia have seen up to a 10% reduction in revision rates.
  • A modest 2% decrease in the U.S. revision rate would yield a savings of$65.2 million in one year.
  • Based on the projected group of these procedures through 2030, the potential savings could exceed $1.3 billion over 20 years.

When a patient has a hip or knee implanted into his body, the device used was chosen by his orthopaedic surgeon based on the patient’s stature and lifestyle as well as the device’s performance. The device longevity is one of the factors that would be able to be monitored by a national joint registry.

A joint registry monitors the artificial joint throughout a recipient’s lifetime in a database with information about the patient, surgeon and facility where the procedure took place. The registry costs are unknown at this point, but could range from $10 to $20 million to operate. The data collected will help doctors to more quickly identify poorly performing products and match patients procedures and devices to optimize outcomes.

One of America’s leading healthcare providers, Kaiser Permanente, has taken the concept of a joint registry and implemented one within their own network. They have over 100,000 joints already registered and believe it has had a positive impact on the quality of care their patients receive.

There are many ongoing efforts to establish local and regional joint registries, however, the AAOS proposes a national, independent, not-for-profit organization outlined below.


William J. Maloney, MD, Chair of the AJRR defines some of the values of registries as:

  • They provide an early warning system for early implant failure.
  • They provide evidence that, if delivered to physicians in a timely and understandable fashion, will positively influence physician behavior to the benefit of patients and society.
  • They have the power to ultimately decrease the burden of disease and cost associated with surgical morbidity and mortality, and reduce the volume of premature revision procedures.

A pilot program to collect data (hip and knee) has been implemented and set to start sometime in late 2010. According to Lewallen, 15 U.S. hospitals will be involved in this pilot.

I hope to get some more information on the progress of this test pilot at this years Annual Academy of Orthopedic Surgeons (Feb 15-19) in San Diego. I will look forward to posting some information on this subject soon thereafter.

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