The orthopaedic joint replacement register for England, Wales, Northern Ireland and the Isle of Man has published a new report highlighting a record number of procedures being performed
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 National Joint Registry (NJR). This sees a significant increase of more than 20,000 joint replacement operations recorded in the registry on the previous period.
The National Joint Registry’s 14th Annual Report presents outcome data in relation to hip, knee, shoulder, elbow and ankle replacements. The published figures bring the total number of records in the registry to approximately 2.35 million since it was established in 2002. The report highlights that for most patients across all joint replacement procedures recorded in the registry:
The risk of having the first-time implant replaced within thirteen years was low
Primary procedures were performed predominately for osteoarthritis or inflammatory arthritis
The average patient* is female, with only ankle replacement procedures showing a male majority.
Commenting on the outcome data and statistics presented in the report, NJR medical director Martyn Porter, pictured left, said: “The consistently high number of joint replacement cases submitted per year suggests continuing high levels of patient confidence and clinical performance, in what is a remarkably successful surgical intervention.
“Specifically in the case of hip replacement, the 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 gets patients back to their chosen lifestyle sooner, free from pain and with improved mobility.”
Elsewhere, however, analysis from this year’s report continues to show the trend for increased likelihood of revision surgery associated with younger patients across all types of joint replacement procedures recorded in the registry. Younger patients may be at higher risk of revision because they are 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. Porter, a revision specialist, said: “This trend is particularly relevant given the increase in total numbers of younger patients undergoing joint replacement. If younger patients are most likely to need at least one revision surgery in their lifetime, then we must use the maturing dataset of the NJR to get the first-time surgery as right for the patient as possible.
“While standards in British orthopaedics are high, surgeons must continue to use the NJR’s rich dataset to see important determinants that influence the outcome and longevity of joint replacement procedures, to evaluate where additional benefits for patients can be maximised.
“This can be achieved 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 young hip and knee replacement patients in the pre-operative decision-making process, the NJR has, for the first time, presented findings on the effect of age and gender on hip and knee revision rates across the various types of implants and fixation methods.
The results of the report were launched at this year’s BOA Annual Congress in Liverpool to an international delegation of more than 1,000 joint replacement surgeons.
The full report and joint replacement clinical activity data is available online via www.njrreports.org.uk.
On the collection of joint replacement data, NJR chairman Laurel Powers-Freeling said: “Patient registries serve an invaluable function if we want the NHS to be the safest healthcare system in the world and anyone who chooses to have a joint replacement procedure has the right to safe care.
“This report should drive greater confidence in the public and with commissioners of healthcare, that joint replacement is one of the most effective interventions that the NHS has to offer.
“The NJR remains committed to improving the quality of our data to ensure 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 a sharp focus on patient outcomes.”
*Average gender, age, health of patient, and the most common indication for surgery: these data are presented in the NJR’s summary of key facts about joint replacement during the calendar year 2016 on pages 26 and 27 of the report.
NJR medical director Martyn Porter talks about the importance of the National Joint Registry and its report
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.
The NJR’s remit has naturally broadened since inception and the ability for the dataset to drive forward change in other areas has grown – from patient-recorded outcome measures (PROMs) to implant price-benchmarking, from musculoskeletal research to surgeon accreditation. As well as now also being an important source of evidence for regulators, such as the Care Quality Commission (CQC), to inform their judgements about services and providers.
The NJR’s Annual Report is a fundamental pillar in all of this and not only showcases how we actively monitor the performance of implants, hospitals and surgical technique but also how the registry is driving quality improvement in the orthopaedic sector as a whole.
With the launch of the results of our 14th Annual Report, 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.
The increase in cases submitted during 2016/17 could also be in part due to the NJR’s sustained programme to improve data quality and compliance in the registry. Namely, this has been the work surrounding the data quality audits rolled out across all eligible NHS hospitals and, for the first time during 2016/17, independent sector hospitals too. The programme, now in its third year, has allowed a retrospective comparison of patient records in local hospitals’ databases to those uploaded to the registry, with the aim of ensuring the accuracy of the number of arthroplasty procedures submitted, compared to the number carried out.
As such, the NJR has been able to work with hospitals to improve their NJR processes, to ensure that all eligible primary and revision joint replacement operations are recorded on the database, and importantly put forward for analysis. You can read more about the NJR’s data quality work and its progress on pages 18–20 in the Annual Report.
Outcomes data emerging from the registry show continuing trends, with the risk of having the first-time implant replaced within thirteen years remaining low. Specifically in the case of hip replacement, the 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. While standards in British orthopaedics are high, 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 young hip and knee replacement patients in the pre-operative decision-making process, we have, for the first time, 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.
Established in 2002 by the Department for Health, the NJR monitors the performance of hip, knee, ankle, elbow and shoulder joint replacements to improve clinical outcomes for the benefit of patients, clinicians and industry. The NJR is part of the National Clinical Audit and Patient Outcomes Programme.
