Academic literature on the topic 'Joint Replacement Registry'

ObjectivesThe association of joint replacement registries with outcomes such as revision burden is uncertain. This study aimed to evaluate whether joint replacement registries are associated with the burden of revision changes while controlling for confounders that could affect the association.DesignA longitudinal study involving a combination of cross-sectional and time series data from 1980 to 2018. The study was a panel regression analysis using the difference-in-difference method.SettingData from countries with joint replacement registries and countries without joint replacement registries were used. Registry data were obtained from joint replacement registries’ annual reports, while non-registry data were obtained from each included country’s pooled hospitals’ annual revision burden reported in the literature.Outcome measuresChanges in revision burden from 1980 to 2018 was the outcome measure. The revision burden in the registry periods of registry countries was compared with the non-registry periods of registry and non-registry countries.ResultsData were obtained from 12 registry periods and 8 non-registry periods. The average difference in revision burden in the registry periods of registry countries relative to the non-registry periods of registry and non-registry countries was statistically significant for hip, −3.80 (95% CI (−2.50 to −5.10); p<0.001) percentage points and knee, −1.63 (95% CI (−1.00 to −2.30); p<0.001) percentage points. This translates to a 19.30%, and 21.85% reduction in revision burden for hip and knee registries, for the whole sampling period.ConclusionJoint replacement registries are associated with a significant reduction in the burden of revision. Although revision burden reduces over time even without the registries, the establishment of joint replacement registries is associated with an increased reduction. The establishment of joint replacement registries in non-registry countries would be a worthwhile decision as it will further improve the outcomes of arthroplasty surgeries.

Introduction Total joint replacement is one of the most effective and successful surgical interventions. Regular monitoring of these surgical interventions is essential and may serve as a system for early detection of defective prosthesis designs or techniques resulting in the complication rate which exceeds the estimated level. The ideal way to conduct this monitoring is a registry of joint replacements. Purpose Assessment of the structure of primary knee joint arthroplasty at the Federal State Budgetary Institution Vreden National Medical Research Centre for Traumatology and Orthopaedics named and it’s comparative analysis with the data from leading foreign registers to improve the work of orthopaedic surgeons, traumatologists and healthcare organizers by optimizing the surgical tactics in the specialized treatment of patients. Methods The authors reviewed the annual reports published by national registers of knee replacements and compared them with the data of the registry of the Vreden National Medical Research Centre for Traumatology and Orthopaedics to make conclusions that would be relevant to current orthopaedic practice. Results Several results of the survey demonstrate the most significant or unexpected conclusions as according to the registry. These include an extremely large gender imbalance and obesity as two thirds of the patients were overweight. The number of patients with tumors and rheumatological diseases in the structure of knee replacements decreased considerably in the recent years. Designs and types of implants used, patellar resurfacing in arthroplasty, time of surgical intervention and options for postoperative administrations of antibiotics at the Vreden Centre are consistent with general European trends in knee arthroplasty. Conclusions The number of primary knee replacements (including unicompartment replacements) has been increasing annually. The patients admitted for primary knee replacement are statistically very similar to patient population from other countries. The main differences are associated with an earlier age at which arthroplasty is performed, an extreme gender imbalance and a relatively low number of patellar resurfacing in primary knee replacement. The problem of overweight among the population leads to an increased number of knee replacements, complications and lower implant survival rate.

Objective.To determine rates of joint replacement for people with rheumatoid arthritis (RA) and osteoarthritis (OA) and to examine the characteristics of those receiving elbow replacements.Methods.Data were extracted from the New Zealand Joint Registry from 1999 to 2015 and annual rates calculated.Results.Rates of joint replacement increased over time for OA but not RA. Elbow replacement was the only procedure performed more commonly in RA.Conclusion.There has been a substantial increase in joint replacement for OA in New Zealand. For RA, where access to biologics has been limited to those with erosions, joint replacement rates have not declined, with the exception of elbow replacements.

The Australian Orthopaedic Association National Joint Replacement Registry first began data collection on 1 September 1999 and full nationwide implementation commenced in January 2003. The purpose of the Registry is to improve the quality of care for individuals receiving joint replacement surgery. The Registry enables surgeons, academic institutions, governments and industry to request specific data that are not available in published annual reports. There is an established system for identifying prostheses with a higher than anticipated rate of revision (HTARR) which was introduced in 2004. The higher rate of revision for the ASR Hip Resurfacing System was first identified by this process in 2007. There has been a reduction in revision hip and knee replacement over the years that the Registry has been in operation, and the addition of Patient Reported Outcome Measures (PROMs) and data linkage will enable more extensive analysis of joint replacement surgery in the future. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180071

Unicompartmental knee replacement (UKR) is the principal alternative to total knee replacement (TKR) in the treatment of end-stage knee osteoarthritis. It involves less tissue resection, resulting in lower rates of morbidity and faster recoveries compared to TKR. However, UKR has a significantly higher revision rate compared to TKR. As a result, whilst over a third of patients are eligible for UKR, only around 8% receive it. A comprehensive comparison of matched patients undergoing TKR and UKR was undertaken using a large dataset from the National Joint Registry for England and Wales (NJR). Failure rates (revision, reoperation, complications and mortality), length of stay and patient-reported outcomes (PROMs) were studied. Whilst patients undergoing TKR had lower reoperation and revision rates, they had higher rates of morbidity and mortality, longer hospital stays, and inferior PROMs compared to UKR. The main reason for revision in UKR was loosening. In view of the high revision rate in UKR, NJR data was studied to identify modifiable risk factors for failure in UKR. Important patient factors were identified including age, gender and pre-operative function. Surgeons with a higher UKR caseload had significantly lower revision rates and superior patient-reported outcomes. Increasing usage (offering UKR to a greater proportion of knee replacement patients) appears to be a viable method of increasing caseload and therefore of improving results. Surgeons with optimal usage (around 50% of patients, using appropriate implants) achieved revision/reoperation rates similar to matched patients undergoing TKR. Two clinical studies were conducted to establish whether the use of cementless fixation would improve fixation and reduce the revision rate of UKR. Cementless UKR was demonstrated to be safe and reliable, with PROMs similar or superior to those demonstrated in cemented UKR. Patients with suboptimal cementless fixation were examined and pre-disposing technical factors were identified. Finally, using NJR data, the effect of the introduction of cementless UKR on overall outcomes was examined. The number of cementless cases was small, and no significant effect on implant survival was demonstrated. However, patients undergoing cementless UKR demonstrated superior PROMs. These studies demonstrate that UKR has numerous advantages over TKR in terms of morbidity, mortality and PROMs. If surgeons perform high volumes of UKR (achievable by increasing their UKR usage), these advantages can be attained without the large difference in revision rates previously demonstrated. Cementless UKR is safe and provides superior fixation and outcomes in the hands of high-volume surgeons. Further work is needed to quantify the revision rate of cementless UKR, and to assess its results in the hands of less experienced surgeons.

Introduction: Establishing best practice for knee replacement is important given the large number of procedures performed. Research into knee replacement is problematic given that implant failure is a rare event. The logistical and financial costs associated with prospective clinical trials are therefore high. Research using national arthroplasty registers may overcome some of these difficulties. Aim: To assess whether research performed on data recorded by the National Joint Registry for England and Wales has the ability to answer clinically relevant research questions relating to knee replacement surgery. To determine if registry research is able to answer specific clinical questions that are unsuited to prospective randomised clinical trial designs. Methods: Analyses was performed using combined data from the National Joint Registry for England and Wales (NJR) and the Department of Health Patient Reported Outcome Measures (PROMs) project. Results: Nine specific analyses investigated the ability of registry data to ask pertinent clinical questions relating to three areas of practice: unicondylar knee replacement (UKR), total knee replacement (TKR), revision knee replacement (RTKR). Discussion: Registry analyses are well suited to the analysis of rare outcomes such as implant revision and death. In comparison to prospective clinical trial designs they are cheaper, consume less time and resources and have the ability to identify associations and additional factors that may potentially influence outcome. As they use current national data they are more representative of “real-time” national practice and as such overcome some of the problems of generalisability associated with more rigidly designed clinical trials. However, as no information is collected about clinical decision making, drawing strong causal inferences from this type of data is problematic. Conclusion: Using registry data it is possible to answer a range of clinically important research questions. However, due to their limitations, it is necessary to combine information from these observational databases with clinical trial data before robust recommendations that influence clinical practice can be made. The key question researchers have to answer now is how registry data and clinical trial data can be effectively integrated.

Introduction Total Hip Replacement (THR) and Total Knee Replacement (TKR) are effective operations for patients with end stage arthritis who can no longer be adequately treated non-operatively. It is increasingly important that these procedures be closely monitored so that the best results can be achieved for patients and optimum use of health resources achieved. Joint replacement registries collect, analyse and report data on patients undergoing joint replacement surgery and can monitor numbers and changes over time, evaluate outcomes and identify patient and prostheses factors associated with these outcomes. The aim of this thesis is to study the impact of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) on hip and knee replacement in Australia. It will explore whether joint replacement outcomes have improved since the introduction of the Registry and critically assess the role of the Registry in this process. Within this main aim, the thesis addresses 4 specific research questions: 1. How are prostheses that are not performing as well as others in their class identified and what are the consequences of this? 2. How does the AOANJRR monitor the impact of new technology such as computer navigation for TKR and the consequences of this? 3. How does the AOANJRR monitor the introduction and impact of new materials with specific reference to crosslinked polyethylene for both THR and TKR? 4. What role has the AOANJRR played in the change of practice, policies and outcomes of hip and knee Replacement in Australia? Methodology The thesis involves a systematic investigation using data from the AOANJRR to address the research questions. The questions were appropriately defined to retrieve information from the Registry for critical examination and analysis. The basic framework is empirical. The processes and analytical methods used to answer specific quantitative research questions are standard and currently in place at the Registry. The research questions were developed to examine data that could specifically be addressed by the AOANJRR and with minimal information available from other national registries or other sources. These were designed with the aim of determining whether any demonstrated improvements in joint replacement outcomes were likely due to the Registry. Results The revision rates for hip and knee joint replacements have improved since the inception of the Registry. The revision burden for total joint replacement is defined as the proportion of all hip and knee replacement procedures that are revisions. In Australia, the revision burden for total hip replacement has declined from 13.1% in 2002/2003 (the first year of full Registry national data) to 9.8% in 2015/2016. For knee replacements the revision burden has declined from 9.3% in 2002/2003 to 7.4% in 2015/2016. This equates to a 25% reduction in the burden of revision for hip replacement and a 20% reduction for knee replacement over the respective periods. The rate of revision for primary THR has declined from 4.8% at 6 years for the time period 2003-2006 to 3.6% at 6 years for THR performed between 2011 -2014. A similar reduction is also seen for TKR over the same period with a decrease in the rate of revision from 5.1% for procedures performed from 2003 -2006 compared to 3.8% for procedures performed from 2011-2014. The role of the Registry in improving the outcomes of joint replacement is addressed within the context of the research questions. The first paper described the process and the evolution over time of methods the Registry has developed to identify devices with a higher than anticipated rate of revision. As a consequence of reporting these devices, there has been a 67% reduction in THRs and a 76% reduction in the use of TKRs that have been so identified in the following year. The international consequence of this process is followed up later in the thesis. TKR has a higher rate of revision for younger patients and methods to reduce this rate of revision are important. The use of computer navigation results in an overall reduction in the rate of revision for patients < 65 years of age and a reduction for loosening in patients of all ages. 4 The introduction of crosslinked polyethylene (XLPE) results in a prosthesis specific reduction in revisions for both TKR and THR compared to the use of the standard conventional non cross-linked polyethylene. For younger patients, <55 years of age, there is a fivefold reduction in the rate of revision for THR at 15 years compared to the use of conventional non cross-linked polyethylene. The Registry was the first to report a reduction in revision with the use of XLPE for hip and knee replacements. This has important implications and may enable younger patients to undergo surgery, confident of a reduced need for revision in the long term. The penultimate chapter outlines the contribution that the Registry has made to the improved outcomes of joint replacement in Australia by examining the interaction with multiple stakeholders. The chapter illustrates the many ways this has been achieved and uses case examples of feedback with resultant change of practice. The interaction of the Registry with the Australian Government, Regulatory authorities, Industry, and Medical Insurers outlines the importance of involving all stakeholders when striving to improve healthcare outcomes. Conclusion There has been a substantial improvement in the outcomes of hip and knee replacement in Australia over the past 14 years. This thesis outlines the ways by which this has been achieved and outlines the critical role of the Registry in achieving these improved outcomes.
Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 2018

Objectives. This systematic review evaluates the rehabilitation interventions for patients who have undergone (or will undergo) total knee arthroplasty (TKA) or total hip arthroplasty (THA) for the treatment of osteoarthritis. We addressed four Key Questions (KQs): comparisons of (1) rehabilitation prior (“prehabilitation”) to TKA versus no prehabilitation, (2) comparative effectiveness of different rehabilitation programs after TKA, (3) prehabilitation prior to THA versus no prehabilitation, (4) comparative effectiveness of different rehabilitation programs after THA. Data sources and review methods. We searched Medline®, PsycINFO®, Embase®, the Cochrane Register of Clinical Trials, CINAHL®, Scopus®, and ClinicalTrials.gov from Jan 1, 2005, to May 3, 2021, to identify randomized controlled trials (RCTs) and adequately adjusted nonrandomized comparative studies (NRCSs). We evaluated clinical outcomes selected with input from a range of stakeholders. We assessed the risk of bias and evaluated the strength of evidence (SoE) using standard methods. Meta-analysis was not feasible, and evidence was synthesized and reported descriptively. The PROSPERO protocol registration number is CRD42020199102. Results. We found 78 RCTs and 5 adjusted NRCSs. Risk of bias was moderate to high for most studies. • KQ 1: Compared with no prehabilitation, prehabilitation prior to TKA may increase strength and reduce length of hospital stay (low SoE) but may lead to comparable results in pain, range of motion (ROM), and activities of daily living (ADL) (low SoE). There was no evidence of an increased risk of harms due to prehabilitation (low SoE). • KQ 2: Various rehabilitation interventions after TKA may lead to comparable improvements in pain, ROM, and ADL (low SoE). Rehabilitation in the acute phase (initiated within 2 weeks of surgery) may lead to increased strength (low SoE) but result in similar strength when delivered in the post-acute phase (low SoE). No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period following TKA. Compared with various controls, post-acute rehabilitation may not increase the risk of harms (low SoE). • KQ 3: For all assessed outcomes, there is insufficient (or no) evidence addressing the comparison between prehabilitation and no prehabilitation prior to THA. • KQ 4: Various rehabilitation interventions after THA may lead to comparable improvements in pain, strength, ADL, and quality of life. There is some evidence of no increased risk of harms due to the intervention (low SoE). • There is insufficient evidence regarding which patients may benefit from (p)rehabilitation for all KQs and insufficient evidence regarding comparisons of different providers and different settings of (p)rehabilitation for all KQs. There is insufficient evidence on costs of (p)rehabilitation and no evidence on cost effectiveness for all KQs. Conclusion. Despite the large number of studies found, the evidence regarding various prehabilitation programs and comparisons of rehabilitation programs for TKA and THA is ultimately sparse. This is a result of the diversity of interventions studied and outcomes reported across studies. As a result, the evidence is largely insufficient or of low SoE. New high-quality research is needed, using standardized intervention terminology and core outcome sets, especially to allow network meta-analyses to explore the impact of intervention attributes on patient-reported, performance-based, and healthcare-utilization outcomes.