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AJRR releases first public report on arthroplasty data
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The American Joint Replacement Registry recently announced the release of its Annual Report on Hip and Knee Arthroplasty Data, which will help track outcomes of total joint replacement in the United States.
“The annual report is our first public dissemination of information as it relates to total joint replacement in the United States,” William J. Maloney, MD, chairman of the board of directors for the American Joint Replacement Registry (AJRR), told Orthopedics Today. “The goal is for the AJRR to be a quality registry where we are tracking outcomes and looking at implant performance, hospital performance and surgeon performance and looking at risk factors for failure. The data gets more robust and rich as time passes because we are able to track those different factors longitudinally.”
William J. Maloney
National trends
Since its inception in 2008, the AJRR has received data on more than 80,000 procedures. For 2013, 123 hospitals submitted data showing 43,823 total procedures performed with 38% listed as hip procedures and 62% as knee procedures. Revision procedures accounted for 6.6%, according to the report.
For primary or revision hip procedures, osteoarthritis (OA) represented 81.3% of all diagnostic codes and fracture of the femoral neck made up 11.7% of all primary total hip arthroplasties. Total or partial hip replacement represented 90% of all hip procedures. The report also showed OA represented 97.5% of diagnostic codes for primary knee procedures, while total knee replacement represented 95.3% of procedure codes.
Looking at revisions, 151 of 222 revisions were performed less than 3 months after primary hip or knee procedures vs. nine revisions after 1 year. The leading cause of early revision procedures were infection in both primary hip and knee arthroplasty, with periprosthetic fracture as a close secondary cause for primary hip arthroplasty.
The report showed the leading articulation type was a metal head with a polyethylene liner (71.9%), while a metal head with metal liner was the least used coupling (0.1%). For implanted knee components, 75% involved highly cross-linked polyethylene inserts and 25% were standard polyethylene.
“Surgeons will be able to look at what the national trends are and compare it to their practice,” Maloney said. “[The AJRR] is the start of our ability to track what is happening and hopefully be able to identify problems earlier in the process so that less patients are exposed to substandard surgery and technology.”
AJRR accomplishments
In the report, the AJRR also listed accomplishments achieved in 2013, including the addition of 102 hospitals to the list of participating institutions; an expansion of hospital recruitment efforts with the development and hiring of a Program Advancement Associate position, as well as the addition of other personnel; several new collaborations; and the completion of software development and accepted data.
According to Maloney, one of the main focuses in the upcoming year is to continue to enroll hospitals as participating institutions so the report can become more specific and accurate. In addition, we would like to expand our ability to collect level 2 (patient and procedure specific data) and level 3 data (patient reported outcomes). With these enhanced capabilities we plan to pilot a post market surveillance study as well as pilot a collaborative multicenter research study with the American Association of Hip and Knee Surgeons.
“We want to enhance the information in the report for this next year to have more implant specific data as well as more robust data concerning the patient and procedure,” Maloney said. “We want to continue to grow the number of hospitals that are reporting. We are in most states now in the United States, but we have a couple of states left to go and we want to be in all states. We are now collecting data on about 2,000 cases a week and we would like to grow that significantly over the course of 2014 and 2015. I also wanted to notethat Daniel J. Berry, MD, will be the next chair of the AJRR, and is looking forward to taking the registry to the next level enhancing the value to patients, surgeons and hospitals.” – by Casey Tingle
For more information:
William J. Maloney, MD, can be reached at the Stanford School of Medicine, 450 Broadway St., Pavilion A, Redwood City, CA 94063; email: nbella52@stanford.edu.
Disclosure: Maloney receives royalties from Stryker (Mako) and is on the boards for the Western Orthopaedic Association, American Association of Hip and Knee Surgeons, and the American Joint Replacement Registry.