AAOS Registry Program Blog

AJRR Public Advisory Board Is the Voice of the Patient

May 30, 2018 12:00:00 PM

Couple on bikes 

The voice of the patient is evident in the efforts of the American Joint Replacement Registry (AJRR) largely because of contributions from the Public Advisory Board (PAB). The mission of the PAB is to improve the value of AJRR by even more effectively ensuring a public voice in the Registry's hip and knee replacement data collection, reporting, and utilization activities. Each year, PAB members play an important role in compiling a Report to the Public About Hip and Knee Replacements. The Report's registry-driven, evidence-based content is invaluable in answering the most frequently asked questions (FAQs) from patients and their families. Well-informed patients, with current information, will seek better care and gain better outcomes.

AJRR Public Advisory Board Members

This week's blog focuses on the Report to the Public's answers to patients' FAQs. As a complement to the Report, the blog also features Richard Seiden's account of his personal joint replacement experience and the general patient advice he is sharing through an article he recently authored. He has been a PAB member since


AJRR 2017 Report to the Public

The AJRR mission is to improve care through data for patients who receive hip and knee replacements. Data collected will be used by doctors (for process improvement), surgeons (to evaluate replacement materials), hospitals (to study patient safety practices), medical device companies (to see how products perform), and patients (to understand their treatment plan). Here are some quick facts about the Registry from the latest public report:

Quick facts from the 2017 Report to the Public 

FAQs About Hip and Knee Replacements

Q: What kind of information is in the Registry?

A: All joint replacement patient information is privacy protected and includes: age/sex, name of surgeon/hospital, primary (first-time)/revision (re-do) surgery, reason for procedure, recorded complications, and type of artificial joint parts used.


Q: How do I know if my hospital participates in the Registry?

A: You can visit www.ajrr.net to see if your hospital, surgery center, or private practice group is providing data to us. Or you can ask your surgeon.


Q: Why do people have hip replacement surgery?

A: Almost 80% of primary hip replacement operations are done to relieve symptoms of osteoarthritis. About 10% of hip replacements are done to treat a hip fracture.

Hip replacement facts 

Q: Why do people have knee replacement surgery?

A: About 83% of knee replacements are operations done to relieve symptoms caused by osteoarthritis.

Knee replacement facts


Q: Why is there value in patient-reported outcomes (PROs)?

A: A PRO is information on the results of health care that comes directly from patients without being modified or interpreted by health professionals. It is generally collected through a web-based survey process. When combined with clinical assessment, it provides a 360-degree view of the patient's healing and functional status.


>Listen to a patient describe why he chose to participate in a patient-reported outcomes program. 


Q: How do health care institutions select the PRO measures they use?

A: An institution that is utilizing PRO measures to improve clinical care, rather than academic research, will focus on outcomes of physical function and critical symptoms like pain, fatigue, mood, and patient satisfaction. These self-reported domains are measured before and after the procedure to determine if quality of life has improved. By reporting as you progress through recovery, health care providers can make better decisions for patients now and in the future.


A Patient Perspective on Joint Replacement Surgery

Complementary to the AJRR 2017 Report to the Public, PAB member Richard Seiden shares general advice from his personal experience as a joint replacement surgery patient. A Patient Perspective on Joint Replacement Surgery can be reviewed by patients with joint issues to better prepare them for dealing with pre-, day-of-, and post-surgical needs. Mr. Seiden's article content is not a substitute for physician recommendations. Read an excerpt below.


Day of SurgeryPAB Member Richard Seiden

An excerpt from A Patient Perspective on Joint Replacement Surgery by Richard Seiden

Since you will be unable to eat anything after midnight on the day before surgery, it is always best to schedule an early time for the surgery itself. This will avoid headaches from lack of food and water, and it usually assures a timely start of the surgery (since there will be no backup from prior surgeries by the same surgeon on your scheduled day). An early start time also lessens anxiety and possible rising blood pressure.

You will probably meet your anesthesiologist for the first time on the day of surgery. Please make sure that they have reviewed not only your primary medical history, but particularly any difficulties you may have had with prior anesthesia experiences. For example, if you have had problems with intubation through the mouth (due to neck issues), please advise the anesthesiologist that intubation should be through the nose.

If your surgery involves your lower extremities (hips or knees), you should discuss with your surgeon and the anesthesiologist the possibility of using a spinal block rather than intubation. A spinal block, combined with a light sedative, can put you in "twilight," or a heavier sleep while in the Operating Room. You can quickly be restored to normal cognitive function (as early as when the surgery is completed in the Operating Room) so you can avoid spending time in Recovery coming out of general anesthesia. This will enable you to be relocated to a hospital inpatient bed sooner than otherwise would occur. The same type of block, called a scalene block, may be used with upper extremity surgery and also limits the amount of general anesthetic that you will need.

Typically, the surgeon will step out into the Waiting Room to advise family and friends of the outcome of the surgery. Otherwise, the surgeon should visit the patient either later the day of surgery or early the next morning. On that visit, the surgeon will check the incision, check mobility of toes, and may even check the range of motion of the replaced joint.

In Recovery, it is not uncommon for a patient to develop dry lips when coming out of general anesthesia. This will have been exacerbated by the fact that you have not had any food or water for over eight hours; most hospitals will provide a patient with lemon swabs or ice chips to enable the patient to avoid the discomfort of chapped lips.

For hips and knees, you will be visited by a physical therapist (PT) either the day of surgery or the next day. Surgeons and hospitals have their own protocol as to the first visit. The first step will be for the patient to sit up (with the assistance of the PT). Assuming there is no lightheadedness after a few seconds, the PT will run a belt around the waist of the patient, position a walker next to the bed and will assist the patient to rise from the bed, with one hand on the bed and one hand on the walker. The PT will have their foot behind one or both wheels of the walker so it does not roll. Once the patient is fully erect, the PT will ask if the patient is comfortable standing. If so, the PT will ask the patient to "march in place". If everything is okay with balance and lightheadedness, the PT will ask the patient to take a few steps in the room (with the PT standing at their side holding onto the belt). Assuming all is well, the PT will accompany the patient on a walk down the hallway, stopping whenever it appears that the patient has done enough, and then they return to the room.

Later in the day, the PT will return and have the patient stand, walk in the hallway, and go to a set of stairs where the PT will confirm that the patient can safely raise their repaired leg to climb and descend at least four steps. All things being equal, and assuming all other signs are okay, the patient will be able to be discharged from the hospital. Most hospitals will wheel the patient to the curbside for pickup in a wheelchair. The patient should have a walker in the trunk of the car. Someone else should drive the patient home.

A Patient Perspective on Joint Replacement Surgery will be available shortly. To post the complete article to your website, please contact us at AJRRinfo@aaos.org



Download the AJRR 2017 Report to the Public 


Find hundreds of articles, videos, and resources to help manage your patients' bone and joint health at OrthoInfo.


For information about the AJRR RegistryInsights™ platform, speak with a Business Development Representative at (847) 292-0530 or Request A Demo today!


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Topics: Patient Education

A Message for Our Readers

This blog was created by the American Joint Replacement Registry (AJRR), part of the American Academy of Orthopaedic Surgeons (AAOS) Registry Program. The blog is part of our commitment to improve orthopaedic care through the collection, analysis, and reporting of actionable hip and knee arthroplasty data. Our purpose is to communicate with others in the orthopaedic field who share the same commitment. Watch for weekly news alerts, quick tips, actionable checklists, best practices, and research findings posted to this blog. It will be information you can use each week!

The more interactive you are, the greater the value shared. Visit us at www.AJRR.net, speak with a Business Development Representative at 847-292-0530, or follow us on Twitter.

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This Week's Blog

  • Wednesday, May 30, 2018 - AJRR Public Advisory Board Is the Voice of the Patient


This Week’s References

AJRR Public Advisory Board (PAB)

The mission of the PAB is to improve the value of AJRR by even more effectively ensuring a public voice in the Registry's hip and knee data collection, reporting, and utilization activities.

AJRR 2017 Report to the Public

This annual report is prepared to show the public what we are learning about hip and knee replacement surgery in the United States, and how that information is being used to continually improve the quality of patient care.

A Patient Perspective on Joint Replacement Surgery 

Richard Seiden, a PAB member who underwent joint replacement surgery, shares general advice from his personal experience. The advice can be useful to other patients with joint issues and better prepare them for dealing with pre-, day-of-, or post-surgical issues. The advice is not a substitute for physician recommendations.


AJRR RegistryInsights™

As a health care provider of orthopaedic services, you can access information about joining AJRR and RegistryInsights by visiting www.ajrr.net or speaking with a Business Development Representative at (847) 292-0530.  New Call-to-action

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AJRR Staff Writers

AJRR Blog posts are researched and created by AJRR staff writers: Karen Metropulos, Erik Michalesko, and Lori Boukas. If you would like to contact the writing staff, email us at AJRRinfo@aaos.org


This blog shares health care information from a variety of independent expert sources. Some sources offer opinions that may be of interest to other professionals facing similar challenges. Our approach helps ensure diverse, well-rounded presentation of important, often complex health care content. Shared content does not necessarily represent AJRR or AAOS findings and practices.