Surgeon calls for U.S. total joint registry

KOHALA COAST, Hawaii — The benefits of having a national joint registry for hip and knee replacement surgeries outweigh the costs of developing and maintaining such a system, according to an orthopedic investigator.

“In the last decade we have produced a lot of new technology,” William J. Maloney, MD, said at Orthopedics Today Hawaii 2009. “We are now starting to pay the price for some of those technologies.

“If you look at some of the complications that have been reported with the newer technologies such as metal-on-metal hips, ceramics and hip resurfacing, we have no idea how common they are,” he said.

“We, as surgeons, do the best job we can to put the devices in; the problem is that unexpected and adverse outcomes can and do occur,” Maloney said.

“The question in the United States is, is the problem of a significant enough magnitude to justify the expense and resources to develop a registry? I think if you look at the economics, you will clearly see that the answer to that is yes,” he said. Maloney said data from 2000 showed that $2.6 billion was spent on hip and knee replacements, and forecasts predict a doubling of the amount of knee and hip replacements by 2016 and 2026, respectively.

“Revision surgery makes the price of joint replacement go up. New technologies tend to make revisions go up. Despite the advances in technology, our revision burden for hip and knee replacements has hovered around 16% to 18%,” he said.

In Sweden, where there has been a joint registry since the 1970s, the revision burden has hovered around 8% for years, according to Maloney.

One of the most important goals of the Swedish registry has been to provide feedback to the hospitals and surgeons, which Maloney said it has accomplished.

Using clinical evaluations randomized clinical trials and meta-analyses all have inherent problems, and medical device reporting is a joke, he said.

“There are no effective mechanisms for providing outcomes data in a timely fashion. They influence behavior and they have shown to reduce the revision burden,” Maloney said. He said it also gives surgeons and investigators real-time survivorship data.

Reference:
Maloney WJ. Economics of TJR: Value of a joint registry. Presented at Orthopedics Today Hawaii 2009. Jan. 11-14, 2009. Kohala Coast, Hawaii.