Will Orthopedic Registries Improve Joint Surgery Outcomes?

Laird Harrison


February 04, 2016

In This Article

A Data-Based Approach to Orthopedic Surgery

What's the most common reason why total hip replacements fail?

Many orthopedic surgeons would no doubt guess that the answer has something to do with defective devices. But new data from the American Joint Replacement Registry (AJRR)—a national total joint registry whose mission is to improve arthroplasty patient care, with a focus on hip and knee replacements, using data-driven modifications in the behavior of collaborating providers, institutions, manufacturers, payers, and patients—indicate otherwise.

"While there has been focus on the device, when you look at all the reasons for failure, it's things like dislocations of the hip that are really common in the first 90 days" after surgery, says AJRR medical director David G. Lewallen, MD, professor of orthopedic surgery at Mayo Clinic in Rochester, Minnesota. "It relates to surgical technique, choices of implant head size, surgical approach, and patient factors."

Total knee replacements, on the other hand, most often fail because of infection, at least in the first few years tracked by the registry.[1]

Findings like these give a sense of the data that orthopedic registries are starting to produce in an effort to improve the quality of orthopedic care.

New Insights Into What Really Works

Everyone involved in healthcare these days is looking for ways to measure quality. The Centers for Medicare & Medicaid Services, private payers, physicians groups, makers of medical devices, pharmaceutical manufacturers, researchers, and patients all want to know what really works.

Already orthopedic registries in other countries have started to affect healthcare decisions. In Australia, for instance, the incidence of total knee and hip revisions dropped from 14.8% in 1999 to 11.2% in 2009 following the implementation of a joint replacement registry.[2]

In the United States, medical specialty organizations have created their own registries, such as the National Cardiovascular Data Registry (NCDR) for cardiology and the Intelligent Research in Sight (IRIS) registry for ophthalmologists.

The American Academy of Orthopaedic Surgeons (AAOS) planned to take the same approach, says Dr Lewallen, but as it began work, it realized that other stakeholders also had key information about factors that affect the quality of care. "It's something that was impacted certainly by the surgeon, but also by the device and those who make it, by the hospital environment that we function in, and by insurers, because they have policies that influence the behavior of all of these entities," says Dr Lewallen.

Likewise, these stakeholders could also benefit from the data that the registry collects. So the AAOS reached out to representatives of these groups and found that they were interested, Dr Lewallen says.

In addition to representatives from the AAOS and orthopedic subspecialty groups, the AJRR board of directors includes employees of the medical device manufacturers DePuy Synthes and Stryker Corporation, who serve as representatives of the Advanced Medical Technology Association; employees of Anthem and United Healthcare, who serve as representatives of America's Health Insurance Plans; an employee of Skokie Hospital in Skokie, Illinois, as a representative of the American Hospital Association; and a "public representative" from the Informed Medical Decisions Foundation, a research and advocacy organization that works to advance evidenced-based, shared decision-making. In addition, the AJRR Public Advisory Board is composed of representatives from patient advocacy groups.

"We've had some criticism, frankly, from some within our ranks who have been skeptical about whether we could work in a patient-centered way if we have manufacturers at the table, or insurers, that have other interests to consider," says Dr Lewallen. "But when you think about it, everybody has some conflicts of interest, with the exception of the patient. What's been really wonderful is how everybody recognizes the common mission."

AJRR, which was incorporated as a not-for-profit organization in 2010, now has 353,000 patients in its database and is rapidly growing. It collects data on patient identification, basic procedures, and implants from hospitals and has conducted pilot programs to figure out how it can best gather data on adverse events and patient-reported outcomes. It is working to interface with electronic health record (EHR) systems directly.[1]


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