Implementation and Application of a Community Total Joint Registry

Abstract

The Swedish Knee Arthroplasty Register, a prospective national study of total knee arthroplasty that was begun in 1975, and the corresponding Swedish National Hip Register, which was begun in 1979, have had a dramatic impact on joint arthroplasty in that country and have received increasing attention and imitation in recent years1-7. Sharing registry information with surgeons has been an important factor in allowing Sweden to have a rate of revision hip replacement of approximately 8% compared with 18% in the United States4. Such results, as well as the rapid proliferation of arthroplasty options and some notable failures of new technology, have prompted calls for a national joint registry in the United States4. While even the founders of the Swedish registry acknowledge that a prospective, randomized clinical trial is the so-called gold standard for comparing new prosthetic designs8, widespread adoption of such trials seems impractical in the United States for a number of reasons. The general goals of a joint registry (defining the epidemiology of joint replacement surgery, providing timely information about outcomes to the orthopaedic community, and identifying risk factors for poor outcomes) remain unchanged regardless of whether the registry is community-based or implemented at the national level4. We began our community-based total joint registry in 1991, with a database that allowed us to track implant use and failure rates among the forty-four orthopaedic surgeons doing joint arthroplasty in a community health-care system, and with the knowledge that a majority of primary hip arthroplasties in the United States are performed by relatively low-volume surgeons9. Although we were interested in monitoring implant costs, it became immediately apparent that our registry would provide us with valuable information with regard to implant failures in the hands of community surgeons …