AAOS Registry Program Blog

This article was originally published in the June 2018 issue of AAOS Now, the American Academy of Orthopaedic Surgeons' (AAOS) monthly news magazine. It is the first of a three-part series illustrating practical aspects of American Joint Replacement Registry (AJRR) participation through success stories from subscribing institutions. The next installment will feature TriHealth Good Samaritan Hospital and appear in the July issue of AAOS Now.

The AJRR is the largest hip and knee replacement registry in the United States and a leader worldwide.

Providence St. Joseph Health (PSJH) shares highlights of its road to participation in the AJRR including some of the achievements attained along the way. Other health care institutions can learn from PSJH's experience in developing best practices in system-wide data collection (86,990 cases submitted as of January 2018), data-driven quality improvement (patient reported-outcome [PRO] program), and utilization of the data for research purposes (dual mobility cup utilization and indications analysis).

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.

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 2016.

Orthopaedic nurses are important stakeholders in the mission and success of registries. Like other health care practitioners, they improve orthopaedic care through the collection, analysis, and reporting of actionable registry data that contributes to better patient outcomes.

The National Association of Orthopaedic Nurses (NAON) was formed after a meeting convened by Nancy Hesselbach, RN, and Barbara Fiehler, RN, with fellow orthopaedic nurses at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting on March 8, 1980 and incorporated April 14, 1980 in Missouri. NAON's mission promotes orthopaedic research, education, and nursing practice. At their 38th Annual Congress on May 19-22, 2018 in Albuquerque, New Mexico, educational offerings about registries will include presentations from both AJRR and the American Orthopaedic Association (AOA). Today's blog provides a preview of presentation content that helps fulfill NAON's mission, along with making a difference to hospital, physician practice, and nursing quality improvement.

Watch and Learn From 12 International Registry Presentations

The American Academy of Orthopaedic Surgeons (AAOS) is committed to encourage and provide lifelong learning opportunities to its members and that is exactly what it did at the International Society of Arthroplasty Registries (ISAR) Symposium at its 2018 Annual Meeting. "What Can a Registry Do for Me?" showcased a dozen real-world data outcome uses from registries around the world and presented data and insights gained through these registry efforts.

ISAR members have a shared purpose of improving outcomes for individuals receiving joint replacement surgery worldwide. The focus of the society is to utilize the strength of cooperation and sharing of information and further enhance the capacity of individual registries to meet their own aims and objectives. 

A recording and slide presentation of "What Can a Registry Do for Me?" is organized under four subject areas:

• Part 1 - Health Care Quality and Payment
• Part 2 - Identify Clinical Best Practices and Improve Patient Care
• Part 3 - How to Use Your Own Data
• Part 4 - Implant Selection and New Technology

Today's blog provides a "front-row seat" for you to listen and view the complete symposium content. Symposium highlights are also below.

This week's blog will guide AJRR participants in updating their 2018 Registry workflows, data submission capabilities, and case analysis efforts. After listening to and incorporating participant feedback, AJRR Data Specifications 07.13.2017 Revision 1 and AJRR Data Dictionary Version 2 were released on April 30, 2018. These Registry upgrades added new data elements and deleted, merged, and renamed data fields to create a more user-friendly and comprehensive Post-Operative Complication (Post-Op Comp) File Layout. AJRR has three layouts that it asks participants to submit: the Procedural Layout, Patient-Reported Outcome Measures (PROMs) Layout, and Post-Op Comp Layout.

The new Post-Op Comp Layout contains important Level II measures that will, for the first time, allow for risk-adjusted case analysis.

In the American Joint Replacement Registry (AJRR) 2017 Annual Report, infection was identified as a leading cause of total knee arthroplasty (TKA) and total hip arthroplasty (THA) revisions from 2012 to 2016. The majority of early (<3 months) linked TKA revisions are for infection. The majority of early (<3 months) linked THA revisions are for dislocation, infection, and periprosthetic fracture. With an increasing number of TKA and THA procedures being performed in the United States, the rate of failure has also increased. In 2017, AJRR compared and analyzed data for infection-related revision surgeries from six arthroplasty registries including AJRR. The authors presented their poster at the International Society of Arthroplasty Registries (ISAR) 6th International Congress (May 2017). The results showed that for both hip and knee arthroplasty, each registry with six-year data showed an increase in infection burden over the period of the survey.

The demographics and treatment of femoral neck fracture (FNF) patients have evolved over time. Today's blog uses data from multiple sources to provide orthopaedic surgeons with insights and decision support regarding changing trends in FNF clinical practice. Our primary source is the American Joint Replacement Registry's (AJRR) 2017 presentation at the International Society of Arthroplasty Registries (ISAR) Annual Meeting*. Since the presentation, AJRR has continued to analyze new FNF Registry data and will again share findings at ISAR's 2018 meeting. Our second notable source is a published study in The Journal of Bone and Joint Surgery: "Nationwide Analysis of Femoral Neck Fractures in Elderly Patients" (Volume 99-A, Number 22, November 15, 2017)**.

You've chosen the American Joint Replacement Registry (AJRR) for your registry needs and the contract is signed! Now, as an AJRR participating institution, it is time to make RegistryInsights™ work for your hospital(s), surgeons, and patients. How fast and easy is implementation? This week's blog walks you through the timeline, tools, relationships, and resources that will make your AJRR participation thrive. If you are an existing participant, here's how you could maximize your support offerings. If you are just getting started with your Registry efforts, consider this a roadmap of first steps.

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.

Plus Highlights From the Annual In-person Unet Meeting

In 2017, and again in 2018, the AJRR User Group Network (Unet) more than doubled its registered members over the prior year*. Since its inception, the Unet value equation has been defined by benchmarking, shared experience, and best practice learning opportunities. Quarterly calls/webinars and the annual in-person meeting help forge collaborative user relationships and provide exposure to guest experts in the registry field. For real-time answers to immediate challenges, participation in the Unet Forum is available. Speak with someone who has already been there, and done that! Find minutes and slides from previous Unet calls and in-person meetings in the Unet Forum. Engagement is free and the rapidly growing number of registrants speaks to the value Unet delivers.

*February 2016, February 2017, February 2018