Abstract
BackgroundWith over 2.35 million records, the National Joint Registry (NJR) is the largest arthroplasty registry in the world. It provides a powerful tool to monitor implant survivorship and influence different surgical strategies. To date, little work has been undertaken to investigate the validity of the ‘Reason for Revision’ recorded in Consultant Outcome Reports on the NJR.MethodsThe NJR was queried to identify all revisions on the THR performed at a single centre over an 11-year period. Review and validation of ‘Reason for Revision’ for each case was undertaken using radiological imaging studies, pathology, histology, microbiology and electronic medical records.ResultsOf the 22,046 primary total hip replacements (THR) and total knee replacements (TKR) undertaken by 23 surgeons at our hospital, over an 11-year period, 1.35% (297) were subsequently reported to the NJR as revised. Discrepancies in reporting to the NJR were identified for 41 cases (25.63%) for THR and 28 (20.40%) cases for TKR. Revision for infection was under-reported for both THR and TKR by 1.88% and 3.65% respectively. Reporting of adverse soft tissue reaction to particulate debris for THR was unreported by 11%. Progressive arthritis following a TKR was unreported by 6.56%. All the cases reported as ‘other’ (8.75% for THRs and 3.65% for TKRs) were reclassified to the most appropriate ‘reason for revision’ category. The ‘reason for revision’ data is recorded to the NJR with findings at the time of surgery. It is some days before microbiology and histology reports become available and source data is not always updated.ConclusionIf an average of 23% wrong data entry at a highly organised institution is replicated throughout the UK, a formal process to validate primary and revision data submitted to the NJR should be considered. Local scrutiny, review and validation of revision data are all vital to optimise the value of the NJR. Accurate data recorded to the NJR is imperative to provide safe and effective improvements in orthopaedic surgery.
Highlights
Implant registries began over 40 years ago with the Swedish Knee Register in 1975 followed by the Swedish Hip Register in 1979
Of the 37,014 operations, 22,046 were included in this study. These comprised of 9411 total hip replacements (THR) undertaken by surgeons and 12,635 Total knee replacement (TKR) undertaken by surgeons
1.70% (160) of these primary THRs and 1.08% (137) of these primary TKRs were reported to the National Joint Registry (NJR) as revised either by the consultant who undertook the primary procedure or by another consultant either at our centre or at another hospital (Table 3)
Summary
Implant registries began over 40 years ago with the Swedish Knee Register in 1975 followed by the Swedish Hip Register in 1979. The National Joint Registry (NJR) was set up by the Department of Health and Welsh Government in 2002 to collect information on all ankle, elbow, hip, knee and shoulder replacement operations. Annual reports generated using the data from arthroplasty registries are increasingly cited in the rationale for aspects of implant selection, component fixation and other variables of surgical practice. One of the outputs of the data recorded in the NJR is Surgeon (Consultant) Reports These are provided directly to the individual consultants detailing their annual and 3-year activity. The 90-day mortality for the consultant’s patients is detailed With such influence on clinical practice, validation of the data reported to the NJR is critical, if the NJR is to be used for feedback and recommendations to the public, hospitals and clinicians and researchers. Little work has been undertaken to investigate the validity of the ‘Reason for Revision’ recorded in Consultant Outcome Reports on the NJR
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