AAOS Registry Program Blog

AJRR Study Yields Insights Into Tracking TJR Revisions

Apr 4, 2018 12:00:00 PM

AJRR poster about tracking TJR revisions

The American Joint Replacement Registry (AJRR), the largest hip and knee replacement registry worldwide, conducted a study analyzing the correlation between hospital size, the reason for revision (or re-do) surgery, and the hospital where the total joint arthroplasty (TJA) revision surgery is performed. The link between these three factors has not been studied extensively until now. A poster on the study's findings was presented at the 2018 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in March. The poster, titled, "Is There a Correlation Between Hospital Size and Revision Indication and Where TJA Revision Surgery is Performed?" can be seen above.


Hypothesis and Methodology

Medicare hospital claims data and beneficiary enrollment data were used for the study. Medicare patients undergoing a TJA revision can sometimes have it performed by a different surgeon or at a different hospital than the primary (or initial) procedure. The study looks at whether there is an association between hospital size and where the revision is performed, and how frequently Medicare patients return to the same hospital or surgeon in the first year for joint infection or dislocation.

"Data on revision rates that depend exclusively on information from the same hospitals where the primary procedures are performed will under report the actual revision rates occurring," said Terence J. Gioe, MD, lead study author, American Joint Replacement Registry, University of California, San Francisco (UCSF) School of Medicine, San Francisco Veteran Affairs (VA) Health Care System.


Patient Migration Findings Suggest Hospital Size Matters

Patients are less likely to visit another hospital for revision if the primary arthroplasty was performed at a large hospital with 450 or more beds, as compared with smaller hospitals with fewer than 150 beds.

  • In hospitals with less than 150 beds, about 76% of revisions within one year were performed at the same hospital. This increases with hospital size.
  • In hospitals with over 450 beds, about 88% of revisions were performed at the same institution.
  • For infection-related revisions within the first year, about 83% were at the same hospital, and about 80% were by the same surgeon.
  • With dislocation-related total hip arthroplasty (THA) revisions, about 87% were performed in the same hospital, and about 83% were performed by the same surgeon.
  • For every additional year after the primary arthroplasty, the likelihood of attending another hospital for revision increased by 9%.

"Although this study looked at Medicare data as opposed to AJRR data, the findings will inform future Registry research projects and will lay the groundwork as the AJRR becomes more diverse and comprehensive," said AJRR Director of Analytics Caryn D. Etkin, PhD, MPH. "It will be interesting to share the results of the study with our international counterparts, and to see if similar trends have occurred on the global scale."


How This Study Informs Future Revision Research Efforts

The magnitude and characteristics of patient migration following TJA have not previously been studied in the US. Loss to follow-up due to patient migration will be a key potential limitation of large-scale studies on implant performance in the US.

"Assessment of loss to follow-up can provide an essential understanding of the migration patterns of TJA patients. This understanding is essential as hospitals seek nationwide data to scientifically support TJA assessment. It will certainly help to improve recruitment and enrollment efforts of AJRR, as hospitals continue to recognize the growing national reach of the Registry," concluded Dr. Gioe.


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Topics: Registry Findings

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) registries portfolio. 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!

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This Week's Blog

  • Wednesday, April 4, 2018 – AJRR Study Yields Insights Into Tracking TJR Revisions


This Week’s References

Total Joint Replacement (TJR) Revision Surgery

A second surgery, necessary when a knee or hip implant wears out or another problem develops after the primary surgery has taken place. The time frame for the second surgery is dependent on the type of problem that has caused the need for a revision.

Revision Burden

Revision burden is the number of revision arthroplasties (also known as replacements) performed during a year divided by the total number of arthroplasties (revisions plus primaries) performed that same year. Revision burden may be seen as a general measure of arthroplasty success in a joint registry, though it is influenced by many factors, and serves as a crude comparator between registries.

Hospital Catchment Area

A hospital catchment area (or market area) is the sum of geographical units from which the hospital draws a majority of its patients.

Patient Migration

Movement of patients from one hospital to another for a wide variety of reasons including, but not limited to: change in physician, availability of specific treatment, insurance coverage, or geographic convenience.


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.