Patient registries serve an invaluable function if we want the NHS to be the safest healthcare system in the world. The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR), the largest of its kind in the world, plays a crucial role in this capacity within the orthopaedic sector. Established in 2002, the registry ensures that the most robust evidence is available to monitor the performance of implants, the effectiveness of different types of surgery and to improve clinical standards—all with an absolute focus on patient outcomes. Mr Martyn Porter, introduces their latest annual report.
The NJR’s remit has naturally broadened since inception and the ability for the dataset to drive forward change in other areas has grown. It is now also an important source of evidence for regulators, such as the Care Quality Commission (CQC), to inform their judgements about services and providers.
As we launch the results of our 14th Annual Report today, this is clearer than ever before. The registry offers the orthopaedic community the critical ability to see important determinants that influence the outcome and longevity of joint replacement procedures.
It is interesting and of significance to view the data emerging from this year’s report in two separate measures. Firstly, data relating to clinical activity for the financial year, and secondly the outcome data in relation to hip, knee, shoulder, elbow and ankle replacements.
On clinical activity, what is interesting to note is more joint replacements than ever before were carried out in the financial year 2016/17, with just fewer than 243,000 cases submitted to the NJR. This sees a significant increase of more than 20,000 joint replacement operations recorded in the registry compared to the previous period. Overall, this brings the total number of records in the registry to approximately 2.35 million. The consistently high number of cases submitted per year suggests continuing high levels of patient confidence and clinical performance, in what is a remarkably successful and cost effective surgical intervention.
Outcomes data emerging from the registry show continuing trends, with the risk of having the first-time implant replaced (known as ‘revision surgery’) within thirteen years remaining low. Specifically in the case of hip replacement, today’s report shows that in the vast majority of patients over the age of 75 at the time of their operation, their hip implant will not need to be replaced again in their remaining lifetime. Similarly, for patients over the age of 75, the data for the most common types of total knee replacement show less than a 3 per cent chance of requiring further surgery at thirteen years.
These are very impressive results and we should not lose sight of the fact that joint replacement helps eliminate pain and offers improved mobility for patients. This is particularly true when you also consider that osteoarthritis was the main diagnosis for primary hip replacement and almost exclusively the diagnosis for primary knee replacement during the 2016 calendar year, in 90 per cent and 99 per cent of cases respectively. Similarly, there are very positive outcomes reflected in the ankle, shoulder and, now for the first time, elbow joint replacement data too.
However, those in the orthopaedic community must continue to note an important trend emerging from the data, which highlights an increased likelihood of revision associated with younger patients across all types of joint replacement procedures recorded in the registry. This may in part be because younger patients may be more active which may put more strain on their implants. There may also be differences between patients which could be due to age or variations in surgery.
Given the increase in total numbers of younger patients undergoing joint replacement, this trend is particularly relevant. Surgeons must continue to use the NJR’s rich dataset to evaluate where additional benefits for patients can be maximised. One way of achieving this is through evidence-based evaluation of the proposed implant, the way in which it will be fixed into place in patients of a particular, age, gender and health.
To assist clinicians and patients in the pre-operative decision-making process, this year we have presented findings on the effect of age and gender on hip and knee revision rates across the various types of implants and fixation methods in this year’s Annual Report.
Ultimately, if patients under-55 years are most likely to need at least one revision surgery in their lifetime, then we must use the maturing dataset of the NJR to analyse long-term trends and get the first time surgery as right for the patient as possible.
The NJR’s Annual Report and additional online content can be downloaded from our dedicated Annual Report website via: www.njrreports.org.uk. As we enter our fifteenth year since inception, everyone associated with the registry looks forward to continued service to patients, clinicians and the orthopaedic sector as a whole.