Posted Mon, 03/14/2011 – 11:57

The American Association of Orthopaedic Surgeons estimates that around 800,000 joint replacements take place in the United States each year, and the time has finally come for the U.S. to establish a joint registry, The American Joint Replacement Registry. The United Kingdom, Australia, and Sweden are just a few of the countries that have national joint registries, which monitor the performances of devices.

A national joint registry is used to gather a patient’s basic information, hospital and surgeon information, the procedure and device used, as well as note if a patient has a revision surgery. The registries are extremely useful in identifying a device that is defective or malfunctioning and is not working on par with other competitive devices. Such was the case with the Australian National Joint Replacement Registry, which reported as far back as 2007 high revision rates for the DePuy ASR hip replacement device. The 2007 report showed the ASR resurfacing device as having twice the revision rate compared to other resurfacing devices, and then from 2008 until the DePuy ASR recall in 2010, the Australian data identified the ASR resurfacing device and ASR XL, used in total hip replacement, as having higher revision rates than competitive devices. When the Australian registry reported the problems with the ASR, most Australian surgeons stopped using the device, and DePuy withdrew the device from the Australian market in December 2009, before the issued Field Safety Notice in March 2010, and well before the actual recall in August 2010.

The United States did not have a national joint registry when the DePuy ASR was being implanted in patients; therefore the statistics regarding the high revision rates for the ASR reported in the Australian National Joint Replacement Registry and then the UK National Joint Registry were available if American surgeons searched for them.

Just this January, the AJRR began a trial of collecting information for three months from 16 various institutions, such as academic centers and private orthopaedic practices. After this pilot run, the AJRR staff will have a better understanding of the challenge of hospital personnel to submit data and also develop a method that works best to report data, as well as create a uniform system for collecting information and monitoring the outcomes of total joint replacements. The AJRR aims to collect data from 90% of U.S. hospitals where hip and knee joint replacements take place over the next five years.

Data from other registries have show a 10% reduction in revision rates, and with the vast amount of joint replacements performed in the U.S., even a 2% decrease of revision rates would lead to a savings of $65.2 million in one year, and a potential of $1 billion in savings over a span of 20 years. The creation of a national joint registry in the United States is long overdue and its establishment will not only help determine early on which devices are not performing to the standards of joint replacement devices, but also reduce revision rates and make the manufacturers more accountable for their products. This will be helpful in avoiding incidences such as the continued implantation in the U.S. of the defective ASR despite reports from other countries showing the problems with the DePuy ASR. Once surgeons will have available to them data showing the performance of a device, they will be able to choose the best prosthesis for patients