What’s the point of a National Joint Registry?
Yorkshire Knee Clinic’s Jim Newman explains the value of having a National Joint Registry – and explains why the careful controls over the information made available are absolutely vital.
We are in a data age – where every product and process eventually finds its way to an algorithm – so perhaps we shouldn’t be remotely surprised by the existence of the National Joint Registry (NJR). Yet back in 2002 when the idea of a record of all knee, hip, ankle, elbow and shoulder replacements became a reality, it was a quiet revolution.
Since its launch, anytime any surgeon has performed any form of joint replacement, the data has been entered onto the register. By logging details of the surgical technique used, the implants involved and the shoulder, hip and knee surgeons carrying out the procedures, we’ve built what by now is 16 years’ worth of invaluable data.
That data has proved vital in distinguishing the surgical implants that perform from the ones that don’t. It has enabled us to build a clear picture of implant effectiveness, durability, complications and more.
Over time, the data has also been used to identify so-called ‘positive outliers’, that is the surgeons who experience the fewest revisions (a revision is an operation to correct something that didn’t quite go to plan originally). It’s worth noting at this point that all of Yorkshire Knee Clinic’s knee surgeons are positive outliers on the register.
As you might expect, there are other surgeons who fall on the other side of the coin, the ones with the most joint failures to their record. These are known as ‘potential outliers’.
A matter of public record?
You may find it surprising that, at present, the NJR only makes mortality rates public, that is, the numbers of people who die following elective knee surgery. Surely, you might think, it’s reasonable that individuals about to undergo knee surgery should know whether their knee surgeon is, in crude league table terms, a Manchester City or a West Bromwich Albion?
In reality, however, the situation isn’t remotely as simple as that. Revisions can happen for many reasons. If, through no fault of his/her own, your knee surgeon uses an implant that proves to be faulty, that’s a revision. If, following a perfectly successful knee operation, you decide to go trampolining against all medical advice, then that will result in a revision too. If you’re an experienced surgeon, you’re more likely to attempt a riskier operation than a new surgeon might – and bigger risks mean a greater chance of revision.
So my view is that the National Joint Registry remains a vital tool for research and understanding, but as long as revision rates remain a mixed bag of circumstance and luck, it’s right that they also remain off the public record.
That’s not to say that we shouldn’t react appropriately to outliers – with proper investigation to distinguish the bad luck from the bad practice. But with huge potential for misunderstanding and loss of confidence (amongst surgeons and the public) I believe the NJR should remain a source of data that is acted upon but not made fully public.
If you are experiencing knee pain, talk to the knee consultants at Yorkshire Knee Clinic now.