AAOS Registry Program Blog

Guest Blog: My Knee Pain Began a Decade Ago While Playing Tennis

Jan 9, 2019 12:00:00 PM

A patient-reported outcomes program can help you choose the right surgeon and facility.

Guest Blogger Tim Mojonnier, author of today's blog on knee pain 

In this article, the AAOS Registry Program’s Public Advisory Board (PAB) member Timothy Mojonnier shares his personal experience as a joint replacement surgery patient. This article is not a substitute for physician recommendations.

Guest Blogger:
Timothy M. Mojonnier
President, Mojonnier & Associates
Educator, Loyola University

My symptoms appeared ten years ago while playing tennis. As I moved towards the net, I felt a stabbing pain in my right knee, so severe that I could barely walk. Upon returning home and getting x-rays, my orthopaedic specialist delivered the news: I had osteoarthritis. She indicated it was likely that I would eventually require a knee replacement; however, for eight years I was able to avoid the surgeon’s scalpel through a combination of physical therapy and medication.


The Surgery Decision 

But during those eight years, my quality of life diminished. Sleep at night was problematic as I shifted and turned in response to the ever-increasing arthritic pain. One day my wife suggested that we take a walk around the block. Twenty yards into the walk, I could go no further. I returned home and iced my throbbing knee. That was the tipping point. The only questions that I had were these: What surgeon and which hospital should I select to do my knee replacement surgery?

The answer wasn’t obvious. I began by scouring the internet searching for ratings of surgeons and medical institutions. In the U.S. there are approximately 719,000 annual knee replacement surgeries (source: Centers for Disease Control and Prevention). Given this volume of procedures, I expected to find a wealth of customer satisfaction data that would inform my decision.

The reports available from the Internet had one thing in common: they lacked data about results. For example, the U.S. News & World Report hospital reputation survey contained information such as the friendliness of the staff. Its scope was limited in that it didn’t include data points about ambulatory surgery centers and community hospitals. In terms of physicians, I unearthed “performance measures” on criteria such as a practitioner’s ability to answer questions or the amount of time spent with each patient. Even basic information - such as the number of knee replacement surgeries performed by a given surgeon - was unavailable. I realized that I had better information about hotels and restaurants than I did about my health care choices. Lacking meaningful data, I did what most people do. I resorted to word of mouth. What I did then, I could do differently today. For example, today a patient can gain valuable information by visiting the American Academy of Orthopaedic Surgeons’ (AAOS) OrthoInfo website


PROs Decision Support  

Fortunately, I was lucky. Two years after my surgery, during a weekend in New York City with my family, I walked an average of 22,000 daily, pain-free steps. And isn’t this the goal of orthopaedic surgery, namely, improving a patient’s symptoms and functioning? Wouldn’t information about a person’s pain levels and mobility be a better measure of health care quality than knowing the average number of minutes that a doctor spends with their patients? Today, unlike when I made my surgery decision, you can find physicians and facilities that collect this data to help inform your surgery decisions.

Feedback about an individual’s symptoms and mobility is known as patient-reported outcomes (PROs), which is any information on the results of treatment that comes directly from the patients without being modified or interpreted by health professionals. In 2016, the American Joint Replacement Registry (AJRR) launched a PRO platform that captures patient-based outcome data. The information is collected through patient-reported outcome measures (PROMs), which are surveys “that capture a patient’s self-assessment of his or her health including health status (mental and/or physical), function, systems, and health-related quality of life. The PROM is a validated questionnaire that converts a symptom into a numerical score; results that a surgeon achieves - as measured by patient feedback - are quantified. As the missing link in health care quality, PROMs close the loop between the treatment received, and the resulting level of satisfaction that the patient experiences.


Choose a Surgeon and Facility That Participate in a PRO Program

In addition, the information from PROMs can be objectively analyzed and fed back to care providers. Then, health care providers can improve care for future patients. Health professionals can use PROMs to monitor individual patient outcomes, like degree of mobility experienced. With this knowledge, treatment plans can be modified to make sure patients are getting the best individualized care. PROMs facilitate a process of continuous improvement of healthcare quality - a benefit to all the stakeholders in the health care system. When de-identified PRO program outcomes are shared publicly, they can inform a prospective patient’s treatment decisions.

The cycle of continuous improvement is depicted in the following diagram:

PROMs: The Cycle of Continuous Improvement


AJRR Provides a PROs Module to Subscribers

AJRR is the central repository for PROMs data about orthopaedic hip and knee surgeries. The Registry’s goal is to capture data - both pre-operatively and post-operatively - to gain information on a patient’s functional recovery on a large scale.

But patient completion and participation rates have been slow to build at many participating sites. Reasons for this are described on page 30 of AJRR’s 2017 Annual Report: “Collecting of PROs can be a challenging issue for even the most ardent and interested institutions and providers with a mobile populace, unclear responsibility for data collection, and lack of a mandate or clear incentive at present. However, methods of embedding PRO collection into the work flow of patient care has shown promise for improving patient participation and completion rates.”

In addition to saving lives, a primary mission of health care is to improve the lives of patients. We need feedback regarding the extent to which the surgical intervention has actually improved the patient’s symptoms.


Motivating Patients to Participate in PRO Surveys

The goal of AJRR is to improve orthopaedic care through data. To realize this goal, in addition to the systemic, top-down changes to the way surveys are distributed and data is collected, the onus is also on patients to complete the surveys that they receive. My advice, as a past patient, is to participate in the survey from your health provider. Take a few minutes and fill it out. The information that you provide will improve the quality of health care that we all receive.

NOTE: This blog shares a single patient experience and is not intended as a substitute for professional medical advice. You can view the AAOS Terms, Conditions and Disclaimers here. AJRR is a part of the AAOS Registry Program.




Porter, M. E. & E.O. Teisberg, (2006). Redefining Healthcare, Boston, MA., Harvard Business School Press.

“Patient-Reported Outcomes Summit for Total Joint Arthroplasty Report” August 31, 2015, The Journal of Arthroplastyhttps://www.arthroplastyjournal.org/article/S0883-5403(15)00894-3/pdf

“Patient Reported Outcomes (PROs) in Performance Measurement,” 1/10/13. National Quality Forum. ISBN 978-1-933875-44-6

Theresa Weldring and Sheree M.S. Smith “ 2013; “Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs),” Health Service Insights, August 4, 2013

AJRR’s Patient-Reported Outcome Measures Guide, http://www.ajrr.net/images/downloads/Data_elements/AJRR_PROMS_GUIDE_2016_FINAL_4-5_FINAL.pdf 



For information about the AAOS RegistryInsights platform, speak with a Registry Engagement Associate at (847) 292-0530 or Request A Demo today!


Be sure to leave a comment in the form below!


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.aaos.org/ajrr, speak with a Registry Engagement Associate at 847-292-0530, or follow us on Twitter.

Subscribe to the Blog Now!

Data Snapshot

Did you know? As of December 31, 2017, AJRR enrollment stood at 1,006 hospitals/ambulatory surgery centers and 61 private practice groups, representing all 50 states and the District of Columbia. More than 95 facilities in California, 62 facilities in Wisconsin, 55 in Texas, and more than 40 in Florida, Indiana, Ohio, Pennsylvania, and Washington participated, while 5 other states had 30 or more participating facilities.

Read more in the AJRR 2018 Annual Report.

Figure 1 from the AJRR 2018 Annual Report


This Week's Blog

  • Wednesday, January 10, 2019 - Guest Blog: My Knee Pain Began a Decade Ago While Playing Tennis


This Week’s References

AAOS Registry Program Public Advisory Board (PAB)

The AJRR Public Advisory Board is now the AAOS Registry Program Public Advisory Board (PAB). Its mission remains the same, to improve the value across current and future AAOS Registry Program registries by effectively ensuring a public voice in their respective data collection, reporting, and utilization activities.


OrthoInfo is the patient education website of the American Academy of Orthopaedic Surgeons (AAOS). The site provides patients and their families with convenient, online access to more than 500 easy-to-understand articles and videos on orthopaedic conditions and treatments, injury prevention, rehabilitation, and healthy living. Learn more here.

Patient-reported Outcome (PRO)

A PRO is defined as any information on the outcomes of health care obtained directly from patients without modification by clinicians or other health care professionals.

Patient-reported Outcome Measure (PROM)

A PROM is a survey that captures a patient's self-assessment of health including status (mental, physical), function, symptoms, and health related quality of life (HRQL). It is an important research tool used in PRO programs.

AAOS RegistryInsights™

As a health care provider of orthopaedic services, you can access information about joining AJRR and RegistryInsights by visiting www.aaos.org/ajrr or speaking with a Registry Engagement Associate at (847) 292-0530.  New Call-to-action

Recent Posts

AAOS Registry Program Staff Writers

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

2018 MarCom Awards Gold Winner 

The AJRR Blog won a Gold MarCom award in the digital media/writing/blog category. The MarCom Awards honor excellence in marketing and communication while recognizing the creativity, hard work, and generosity of industry professionals.

2018 MarCom Gold Award