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NJR 14th Annual Report: significant increase in joint replacement procedures with “very impressive” outcomes

 

19 September 2017

The orthopaedic joint replacement register for England, Wales, Northern Ireland and the Isle of Man has published a new report today (Tuesday 19 September) which highlights a record number of procedures being performed.
  

More joint replacements than ever before were carried out in the financial year 2016/17, with just fewer than 243,000 cases submitted to the National Joint Registry (NJR). This sees a significant increase of more than 20,000 joint replacement operations recorded in the registry on the previous period. 

Today’s National Joint Registry 14th Annual Report presents outcome data in relation to hip, knee, shoulder, elbow and ankle replacements. The published figures bring the total number of records in the registry to approximately 2.35 million since it was established in 2002. The report highlights that for most patients across all joint replacement procedures recorded in the registry:

  • the risk of having the first-time implant replaced (known as ‘revision’ surgery) within thirteen years was low
  • primary procedures were performed predominately for osteoarthritis or inflammatory arthritis
  • the average patient* is female, with only ankle replacement procedures showing a male majority

Commenting on the outcome data and statistics presented in the report, NJR medical director, Mr Martyn Porter said: 

“The consistently high number of joint replacement cases submitted per year suggests continuing high levels of patient confidence and clinical performance, in what is a remarkably successful surgical intervention. 

“Specifically in the case of hip replacement, today’s report shows that in the vast majority of patients over the age of 75 at the time of their operation, their hip implant will not need to be replaced again in their remaining lifetime. Similarly, for patients over the age of 75, the data for the most common types of total knee replacement show less than a 3% chance of requiring further surgery at thirteen years.

“These are very impressive results and we should not lose sight of the fact that joint replacement gets patients back to their chosen lifestyle sooner, free from pain and with improved mobility.”

Elsewhere, however, analysis from this year’s report continues to show the trend for increased likelihood of revision (or ‘re-do’ surgery) associated with younger patients across all types of joint replacement procedures recorded in the registry. Younger patients may be at higher risk of revision because they are more active which may put more strain on their implants. There may also be differences between patients which could be due to age or variations in surgery. Porter, a revision specialist, continued: 

“This trend is particularly relevant given the increase in total numbers of younger patients undergoing joint replacement. If younger patients are most likely to need at least one revision surgery in their lifetime, then we must use the maturing dataset of the NJR to get the first-time surgery as right for the patient as possible.

“Whilst standards in British orthopaedics are high, surgeons must continue to use the NJR’s rich dataset to see important determinants that influence the outcome and longevity of joint replacement procedures, to evaluate where additional benefits for patients can be maximised. 

“This can be achieved through evidence-based evaluation of the proposed implant, the way in which it will be fixed into place in patients of a particular, age, gender and health.”

To assist clinicians and young hip and knee replacement patients in the pre-operative decision-making process, the NJR has, for the first time, presented findings on the effect of age and gender on hip and knee revision rates across the various types of implants and fixation methods.

Further comment from Mr Porter can be found via NHS England guest blog here >

The results of the report will be launched today at the British Orthopaedic Association’s Annual Congress in Liverpool to an international delegation of more than 1,000 joint replacement surgeons.

The full report and joint replacement clinical activity data is available online via www.njrreports.org.uk.

On the collection of joint replacement data, NJR chairman, Laurel Powers-Freeling said: 

“Patient registries serve an invaluable function if we want the NHS to be the safest healthcare system in the world and anyone who chooses to have a joint replacement procedure has the right to safe care.

“Today’s report should drive greater confidence in the public and with commissioners of healthcare, that joint replacement is one of the most effective interventions that the NHS has to offer.

“The NJR remains committed to improving the quality of our data to ensure the most robust evidence is available to monitor the performance of implants, the effectiveness of different types of surgery and to improve clinical standards - all with a sharp focus on patient outcomes.   

“As we enter our fifteenth year since inception, everyone associated with the NJR looks forward to continued service to patients, clinicians and the orthopaedic sector as a whole.”

Established in 2002 by the Department for Health, the NJR monitors the performance of hip, knee, ankle, elbow and shoulder joint replacements to improve clinical outcomes for the benefit of patients, clinicians and industry. The NJR is part of the National Clinical Audit and Patient Outcomes Programme, which is managed by the Healthcare Quality Improvement Partnership.

-ENDS-

Notes to editors
Number of procedures in the registry:  As at 31 March 2017, the total number of procedures submitted to the NJR was approximately 2.35 million.

FINANCIAL YEAR REPORTING: 
1. The 14th Annual Report of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) is the formal report for the period 1 April 2016 to 31 March 2017.

2. Number of joint replacement procedures submitted to the NJR over the last three financial year periods:
o FY2014/15:  226,871
o FY2015/16:  224,470
o FY2016/17:  242,629  [an increase of 20,857 over the previous period]

OUTCOME DATA REPORTING: 
1. The report provides outcome data in relation to hip, knee, shoulder, elbow and ankle replacements, which have been recorded between 1 April 2003 and 31 December 2016 inclusive, whose records had been submitted to the NJR by 28 February 2017.

2. A summary of procedures submitted to the NJR in the calendar year 2016 and made available for outcome analyses in the 14th Annual Report:
o Hip procedures submitted to the NJR: 101,651 (an increase of 3.5% on 2015)
o Knee procedures submitted to the NJR: 108,713 (an increase of 3.8% on 2015) 2015)
o Shoulder procedures submitted to the NJR: 6,967 (an increase of 12.9% on 2015)
o Ankle procedures submitted to the NJR: 836 (an increase of 15.6% on 2015)
o Elbow procedures submitted to the NJR: 722 (an increase of 10.2% on 2015)

3. *Average gender, age, health of patient, and the most common indication for surgery: these data are presented in the NJR’s summary of key facts about joint replacement during the calendar year 2016 on pages 26 and 27.

  
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