Recon

First data flows from national registry tracking joint replacements

By Jaimy Lee

Hospitals for the first time have access to national data on hip and knee replacement surgeries, which are among the most common surgical procedures performed in the U.S. and require expensive revisions when they fail.

An inaugural report published Friday by the American Joint Replacement Registry—the first national medical procedure registry in the U.S.—will include basic information on roughly 43,000 joint surgeries in 2013. It’s a first step toward amassing a pool of information that can help providers judge the performance of the devices and improve the safety and quality of their procedures.

The joint replacement registry gathers data on patients covered by private health plans and Medicare, and it tracks the type of implant and the lot numbers for every procedure. The first round of data, submitted by about 120 hospitals, reflects about 4.5% of the joint replacements conducted every year in the U.S.

It provides a basic snapshot of the procedures performed last year, such as how many patients had hip revisions, how many women had knee surgery, and what diagnostic codes were used.

For example, the mean age of patients undergoing knee procedures was 66.7 years old, which is slightly younger than the patients who had hip surgery. The mean age of those patients was 67.6 years old.

The registry plans to start collecting more complex data in the future.

“It’s a patient-safety issue,” said Jeffrey Knezovich, the AJRR’s executive director. “There have been numerous issues regarding devices that malfunction or do not work properly.”

Some hospital systems such as the Cleveland Clinic and Kaiser Permanente and other state-level organizations such as the California Joint Replacement Registry have established registries to track the performance of medical products, but there have been no national registries in the U.S., and many of the existing registries do not publicly share information.

Another registry, called the Force TJR, that also focuses on total joint replacements, is also in operation. That registry, which is funded by a grant from the Agency for Healthcare Research and Quality, has collected data on 20,000 patients in 22 states.

Hip replacement surgeries, in particular, are a closely watched service line. National registries in Australia and the United Kingdom were the first to identify higher failure rates associated with metal-on-metal hip implants. The ensuing recalls of those implants meant thousands of patients in the U.S. needed costly revision surgeries.

Stryker, the Kalamazoo, Mich.-based devicemaker, this week said it will pay $1.43 billion to settle patient lawsuits related to faulty hip implant systems. Last year Johnson & Johnson announced a $2.5 billion settlement with patients who had to have metal-on-metal hip implants replaced after they were recalled.

The recalls of metal-on-metal hips have also raised questions about the Food and Drug Administration’s product approval pathways.

“We don’t have a post-market surveillance system,” Dr. Kevin Bozic, vice chairman of the orthopedic surgery department at the University of California at San Francisco, told Modern Healthcare in January. “There is no registry, of hip or knee, on the scale that would pick up these kinds of problems.”

A group of organizations including the Pew Charitable Trust and the Blue Cross and Blue Shield Association, recently issued recommendations urging the FDA toexpand the role of registries.

The American Academy of Orthopaedic Surgeons created the AJRR in 2009. It is funded by physician groups, insurers, hospitals and eight manufacturers. The registry is voluntary and has enrolled 383 hospitals looking at roughly 80,000 surgeries. The goal of the registry is to eventually track 90% of the total hip and knee replacements performed every year in the U.S.

“This will have far-reaching benefits to society, including reduced morbidity and mortality, improved patient safety, improved quality of care and medical decisionmaking, reduced medical spending through, among other things, reduction in the number of revision surgeries, and advances in orthopedic science and bioengineering,” the report’s authors wrote.

An individual hospital can either submit data at no cost or pay a minimum of $2,800 a year to have access to the registry’s dashboard, where they can compare their own data with national de-identified benchmarks.

A joint replacement registry in Sweden has helped that country have the lowest national revision rates for total hip and knee replacements, Knezovich said.

Follow Jaimy Lee on Twitter: @MHjlee

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Josh Sandberg

Josh Sandberg is the President of Ortho Spine Partners and Partner for The De Angelis Group. He also serves as Co-Founder and Editor of OrthoSpineNews.

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