AAOS Registry Program Blog

This blog is the second in a three-part series reporting on orthopaedic studies presented at the 2019 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting and utilizing American Joint Replacement Registry (AJRR) registry data. All presentations are reported by Terry Stanton, senior science writer for AAOS Now.

Paper 877, “An Early Look at Patient-Reported Outcome (PRO) Data” was presented by Kevin J. Bozic, MD, MBA, chair of the AJRR, on Thursday, March 14, 2019 at the AAOS Annual Meeting in Las Vegas, Nevada. The study offers an “early look” at patient-reported outcome (PRO) data from the AJRR, a part of the AAOS Registry Program. Dr. Bozic explained that the study covered differences between patient-reported outcome measures (PROMs) from submitters and nonsubmitters and the response rates tallied so far for PROMs.

This blog is the first in a three-part series reporting on orthopaedic studies presented at the 2019 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting and utilizing American Joint Replacement Registry (AJRR) registry data. All presentations are reported by Terry Stanton, senior science writer for AAOS Now.

Paper 145, “National Trends in Treatment of Femoral Neck Fracture” was presented by Bryan D. Springer, MD, vice chair of AJRR, on Tuesday, March 12, 2019 at the AAOS Annual Meeting in Las Vegas, Nevada. The study tracked trends in the treatment of femoral neck fractures (FNFs) based on data from the AJRR and found that although hemiarthroplasty remained the predominant mode of treatment over the five-year study period, use of total hip arthroplasty (THA) increased significantly during that time.

The American Academy of Orthopaedic Surgeons (AAOS) Registry Program collects data within multiple orthopaedic anatomic registries, thereby creating the exciting potential for analytic insights that improve patient outcomes. In February 2019, AAOS launched the AAOS Registry Analytics Institute and that potential is now an attainable reality for many clinicians! The Institute gives clinicians and clinician-scientists the opportunity to submit proposals for analytic insights that are contained within its various Registries. For example, the American Joint Replacement Registry (AJRR) houses more than 1.5 million hip and knee procedures that can inform quality improvement. The goal of the Institute is to provide a resource to the scientific community to further understand and improve orthopaedic and musculoskeletal care by making information available to examine outcomes related to orthopaedic treatment.

The American Joint Replacement Registry (AJRR), part of the American Academy of Orthopaedic Surgeons (AAOS) Registry Program, is the largest orthopaedic hip and knee registry in the world by annual procedure count. The AJRR 2018 Annual Report’s at-a-glance summary of key insights related to total hip arthroplasty (THA) and total knee arthroplasty (TKA) is shared below. This summary format and content is a perennial favorite of our blog readership. We have tracked and reported these measures in previous years and some trends have emerged. The blog also discusses some of the Registry’s new analytic capabilities and what they contribute to current and future Registry findings.

New Data, New Initiatives, and New Collaborations

The American Joint Replacement Registry (AJRR), part of the American Academy of Orthopaedic Surgeons (AAOS) Registry Program, releases its 2018 AJRR Annual Report on hip and knee arthroplasty data today at the American Association of Hip and Knee Surgeons (AAHKS) 2018 Annual Meeting. The Annual Report is also available for download. AJRR is the largest orthopaedic registry in the world based on annual procedures submitted. Analysis of the latest Registry data yields new insight into U.S. hip and knee arthroplasty practice. This is the fifth annual report that AJRR has released.

Measurement of volume metrics are important to the American Joint Replacement Registry (AJRR) because they provide indicators and insights into our data and in what areas we need to focus and improve. With over 1,000 contracted hospitals/surgery centers providing data on more than 8,000 surgeons, annually we collect more arthroplasty procedures than any other registry in the world. Over 1.3 million hip and knee arthroplasty procedures are currently housed in the AJRR database.

AJRR began the Registry because no national comparator for arthroplasty existed. Each year, AJRR makes significant and actionable progress toward becoming that premier resource. Furthermore, we take measures toward demonstrating that our data is both relevant and nationally representative through multiple statistical analysis efforts. Two of those efforts are highlighted below (one is ongoing):

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.

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)**.

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.