Initiating a Multisubspecialty Orthopaedic Outcomes Program and Utilizing the Data to Guide Practice

Abstract

Evidence-based medicine integrates research findings, clinical expertise, and patient values to provide the highest quality patient care. An orthopaedic outcomes database can assist surgeons in assessing associations between surgical procedures, function, survivorship, complication rates, patient satisfaction, and quality of life as guidance for practice. Outcomes are used to validate techniques or procedures, to benchmark best practices, and to identify areas requiring more clinical research. Tracking the success and failure rates of implants and surgical procedures is important. An outcomes database allows for short-term, midterm, and long-term prospective follow-up studies of specific cohorts and also facilitates studies that are retrospective in design. Several countries have initiated orthopaedic outcomes registries or databases. The oldest registry is the Swedish Knee Arthroplasty Register that was started in 19751. Other countries have followed with the development of their own joint registries in England, New Zealand, Germany, Finland, Denmark, and Norway2-7. In 1994, the American Academy of Orthopaedic Surgeons (AAOS) attempted to create an outcomes evaluation system. The Musculoskeletal Outcomes Data Evaluation and Management System did not come to fruition and was terminated in 2000. The attempt was made to collect information on patients undergoing total hip and knee arthroplasty or spine surgery. Difficulties were multifactorial, but were mainly due to inadequate data, record-keeping, or follow-up, which made cleaning the data to extract useful information impossible8. Although the United States lacks a national orthopaedic registry, several institutions have developed their own databases. For example, Mayo Clinic initiated a database in 1969 that included over 56,000 joint arthroplasties by 19979. The Anderson Orthopaedic Research Institute has over two decades' worth of hip and knee arthroplasty outcomes in its database10, while the Center for Hip and Knee Surgery in Indiana11, the Hospital for Special …