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Baby boomers benefit from highly successful joint replacement surgery

25 September 2013

The National Joint Registry for England, Wales and Northern Ireland (NJR) launches its 10th Annual Report today at an event to celebrate its 10th anniversary (2003-2013). 

  • Nearly 180,000 patients in England and Wales underwent joint replacement surgery in 2012 - patient evidence suggests significant benefits
  • 2012 saw hip and knee replacements rise 7% due to baby-boom population bulge
  • Since its formation, more than 1.4 million joint replacement operations have been recorded

Highly beneficial joint replacement surgery
For the first time, the report includes analysis of NHS England Patient Reported Outcome Measures (PROMs) for hip and knee replacements. PROMs are pre- and post-operative questionnaires (at six months) that ask patients about their experience and perspective of the quality of care and treatment received.

More than 190,000 questionnaires were analysed between April 2009 and December 2012 and revealed that:

Hips

  • More than 90% hip replacement patients had ‘excellent,' ‘very good' or ‘good' satisfaction following the operation
  • More than 85% said their problems were ‘much better' now compared to before the operation

Knees

  • More than 80% had ‘excellent,' ‘very good' or ‘good' satisfaction following the operation
  • More than 70% said their problems were ‘much better' now compared to before the operation

NJR Chairman and hip replacement patient Laurel Powers-Freeling commented "Only by including the patient's view of their outcome can we start to build the full picture of success following joint replacement. The analysis in this year's report is a significant first step towards that and we are confident that PROMs will be a firm feature of our future work."

The future analysis of PROMs information, along with NJR data, will also include the results of the extended NJR-funded PROMs programme that will look at patient responses at one, three and five years after their joint replacement operation.

These data can be seen as reassuring at a time when the NJR 10th Annual Report shows, for 2012, more than a 7% increase in the number of hip (7.5%) and knee (7.3%) procedures carried out in 2011.

NJR Editorial Board Chair and orthopaedic surgeon Martyn Porter added "The average age for hip and knee replacement has changed little in the past decade but there are factors contributing to the increase in the numbers being done. The large population bulge, as a result of the post-war baby boomers, is having an impact as this generation are moving into the age band where joint replacement surgery is more likely. Additionally, the success of hip and knee replacement surgery over the past three decades has allowed younger-than-average patients to be considered too."

Headlines for all joints 2012

  • On average, hip, knee, ankle, elbow and shoulder joint replacement patients were:
  • Aged between 64 and 74 years old
  • ‘Overweight' or ‘obese'
  • Women, with only ankle replacement procedures showing a male majority
  • Diagnosed with osteoarthritis or inflammatory arthritis
  • Treated in the NHS

The future of joint replacement
At an invitation-only 10th Annual Report launch and anniversary reception event held at the Royal College of Surgeons today, patients will join surgeons, healthcare providers and government representatives in an audience-led panel debate to discuss joint replacement in the next 10 years.

Chaired by Dame Jenni Murray, hip replacement patient and host of BBC Woman's Hour, the focus is likely to be on evidence-based practice and anticipated changes in orthopaedics using NJR data, and wider afield, for the benefit of patients.

10-year achievements
The NJR is currently the largest registry in the world for hip, knee, ankle, elbow and shoulder joint replacement procedures. Since its formation in 2003, the NJR is proud to have achieved:

  • Extension to include ankles in 2010 and elbow and shoulder replacements in 2012
  • Extension to Northern Ireland in February 2013
  • Development of robust processes to monitor implant performance, which resulted in the reporting of early failure rates for metal-on-metal implants to the MHRA with in-depth research commissioned following the decline in use of this type of implanted device
  • Development of world-first feedback systems and reports allowing surgeons, manufacturers and hospitals access to their data via dedicated websites
  • Publication of hospital-level and consultant surgeon-level information
  • The establishment of a Patient Network to ensure that the patient voice is at the heart of the registry's decision-making and future development
  • Contributing to the international debate on implant safety and engaging in new initiatives such as Beyond Compliance to drive up surveillance of new implants
  • Funding NJR Research Fellows and supporting access to NJR data in order to maximise understanding and knowledge that, in turn, will result in better care

Vice-Chairman of the NJR Steering Committee and orthopaedic surgeon Professor Paul Gregg commented: "The NJR has developed substantially in its first 10 years and interest in the evidence grows here at home and across the globe. The data can not only be used to check on the performance of implants already widely in use but also, for example, to monitor closely the performance of new implants to the market. 2013 saw the publication of surgeon data for the first time and the second publication of hospital-level information. As a result, we are committed to driving up the quality of our information and remain persistent in our work to ensure that all hospitals input data comprehensively, consistently and without error."

Notes

SUMMARY OF KEY FACTS ABOUT JOINT REPLACEMENT 2012

Hips recorded since April 2003
• 86, 488 hip replacement procedures - an increase of 5% over 2011 (80,314)
• Average age was 67.2 years old for men and 69.7 for women
• 60% were female
• Diagnosis was recorded as osteoarthritis in 92% of cases
• Body Mass Index - Average BMI for men and women was 28.7 ‘overweight'

Knees recorded since April 2003
• 90,842 knee replacement procedures - an increase of 7% over 2011 (84, 653)
• Average age was 68.9 years old for men and 69.5 for women
• 57% were female
• Diagnosis was recorded as osteoarthritis in 98% of cases
• Body Mass Index - average BMI for men and women was 30.8 ‘obese'

Ankles recorded since April 2010
• 590 ankle replacements were recorded - 492 were recorded in 2011
• Average age was 68.8 years old for men and 64.7 for women
• 58% of patients were male
• Diagnosis was recorded as osteoarthritis in 84% and inflammatory arthritis in 13%
• Body Mass Index - average BMI for men and women was 29 ‘obese'

Elbows recorded since April 2012 (nine months)
• 288 elbow replacements were recorded
• Average age was 65.6 years old for men and 66.9 for women
• Diagnosis was recorded as inflammatory arthropathy in 33% of cases and osteoarthritis in 32%
• 67% of patients were female

Shoulders recorded since April 2012 (nine months)
• 2, 225 shoulder replacements were recorded
• Average age was 68.8 years old for men and 73.2 for women
• 72% of patients were female
• Diagnosis was recorded as osteoarthritis in 61% and cuff tear arthropathy in 24%

  

  
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