About the NJR

The National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man and Guernsey, is described as a ‘global exemplar’. We collect information on hip, knee, ankle, elbow and shoulder joint replacement surgery and monitor the performance of joint replacement implants. Joint replacements have become more common and are generally highly successful operations that bring many patients improved mobility and relief from pain. Many thousands of such operations take place in the UK each year and we have been collecting data since April 2003, although data submission for NHS organisations has only been mandatory since April 2011.

A wide range of implants can be used in joint replacement operations and by collecting data on outcomes, the registry monitors the performance of these implants and the effectiveness of their use in different types of joint replacement, with a key focus on patient safety and improving clinical standards; benefitting patients, clinicians and the orthopaedic sector as a whole.

The NJR brings many benefits to the hospitals in which data is collected by providing an annual clinical report on their performance outcomes and a regional support network – an overview of these and other NJR benefits can be found in this summary here.

We are hosted by the Healthcare Quality Improvement Partnership (HQIP), an independent organisation led by the Academy of Medical Royal Colleges, The Royal College of Nursing and National Voices. As host, HQIP is responsible for NJR’s compliance with the necessary legal and statutory frameworks. Our strategic direction, budget and operational activity is overseen by our Steering Committee (NJRSC), which is designated as an NHS England (NHS E) ‘Expert Committee’ and our Chair reports directly to the NHS E Medical Director. Eight NJR sub-committees sit under the Steering Committee, with responsibility for monitoring many key NJR work areas.

Our core services are delivered under two separate contracts, held with: NEC Software Solutions: for the collection and management of data; and the University of Bristol: for the provision of statistical support and analysis of data; work enabling outcome monitoring; some NJR research activity; and analysis for our the different joint sections within our Annual Report.

The NJR Management Team is responsible for overall operational and contract management of the registry and for supporting the work of the NJRSC and our sub-committees; as well as for communicating with our stakeholders about the work of the registry.

Timeline of registry data collection

  • The NJR was established by the Department of Health and Welsh Government in 2002 to capture data about procedures for hip and knee, following the 3M Capital Hip Implant Failure Report, 2001.
  • Data collection commenced April 2003 (now in our 19th year).
  • Submission of data to the registry has been mandatory for independent sector since 2003 and for NHS trusts since April 2010 – the current compliance rate is circa 95%.
  • Data collection was extended to include ankles in 2010 and elbows and shoulders in 2012.
  • Northern Ireland joined the registry in 2013, the Isle of Man in 2015,and Guernsey in 2019.
  • The largest orthopaedic registry in the world – with currently around 3.5 million records and cited as a ‘global exemplar’ internationally.  
  • Around 250k records are usually submitted annually, with year-on-year growth.

Our mission statement

The key purpose of the National Joint Registry, which covers England, Wales, Northern Ireland, the Isle of Man and Guernsey, is to collect and analyse high quality and relevant data about joint replacement surgery in order to provide timely warning of issues relating to patient safety.

In a continuous drive to improve outcomes and to ensure the quality and cost-effectiveness of joint replacement surgery, we will monitor and report on outcomes, alongside enabling and supporting related orthopaedic research.

Our purpose

  • Monitor in real time the outcomes achieved by brands of implants, hospitals and surgeons level, and highlight where these fall below an expected performance level to enable early investigation and immediate follow-up action.
  • Inform patients, clinicians, providers and commissioners of healthcare, regulators and implant suppliers of the outcomes achieved in joint replacement surgery.
  • Evidence variations in outcome achieved across surgical practice, in order to inform best practice.
  • Enhance patient awareness of joint replacement outcomes to better inform patient choice and patients’ quality of experience through engagement. 
  • Support evidence-based purchasing of joint replacement implants for healthcare providers to enable quality and cost-effectiveness.
  • Support suppliers in the routine post-market surveillance of implants and provide information to clinicians, patients, hospital management and the regulatory authorities.

Our strategic plan

The NJR has grown considerably since its inception 2002 and recognising the increased role and ability to support improvements in patient safety and clinical outcomes, we regularly re-assess our strategic goals as part of the development of the registry’s 3-year strategic planning work.

  • You can download the previous NJR Strategic Plan for 2018-21 here.
  • We are currently working on our Strategic Plan for 2022-2025, which we will share here soon, once it has been approved by the NJRSC.

Data security and confidentiality

Staff use a secure electronic data entry system in hospitals to input information for each of their department’s joint replacement procedures.

This information is held securely within the registry and included with all the information about the implant used and type of surgery, the patients’ personal information is also collected (subject to patient consent). This means that if there are ever any problems with any implant we can advise a patient’s hospital that they should contact them to follow-up and check everything is okay.

 All the data held on the registry is encrypted to provide secure protection.  NJR data collection and processing activities are fully compliant with GDPR and Common law duty of confidentiality. Our data processing locations are ISO027001 certified – patient data is in safe hands.

Who can use the data?

Patients’ personal data is treated as confidential at all times and cannot be used outside of the registry. This personal data is only available to the patient that it relates to and their surgeon.

Procedures are in place to protect the information and to keep it confidential. Data collected in the registry may be used for research but only if the application to do so has been reviewed and approved by the NJR Research Committee and also only if the outcomes that are expected will provide significant benefit to the future healthcare of patients. However, any data provided for research work will be de-identified so that it is not likely to identify any individual.

In accordance with the Data Protection Act (2018), patients can request a copy of their personal information that is held in the registry at any time. 

Please see our Patient Section or contact the NJR Service Desk for further information.

Governance

The NJR Steering Committee (NJRSC), which meets four times per year, is responsible for the strategic direction and operational oversight of the registry and is an NHS England ‘Committee of Experts’.

NJR Committee Structure

The NJRSC is supported by the NJR Management Team, who are hosted by HQIP. The team is responsible for the overall operational and contract management of the registry and for supporting the work of the NJRSC and its nine sub-committees.

Funding

Delivery of the NJR’s strategic work programme is funded through a mandated annual hospital subscription charge which is calculated by being based on the contractual costs of running the registry and delivering the work programme agreed. The NJR’s income and expenditure is overseen by our Steering Committee and is a restricted fund, spent in accordance with the agreed strategic plan.

Our Executive Committee undertakes an annual review of the pricing and resources required for delivery of our strategic work programme to ensure continued value for money in the delivery of our range of products and services. This exercise is underwritten and agreed by the Steering Committee and validated by NHS England.

The NJR is funded through a subscription service whereby payments from NHS trusts and independent providers of joint replacement surgery are based on their surgical volumes for the previous year. 

With effect from the 1 April 2019, the NJR subscription has been at a rate of £16.54 [gross],£13.79 [net] per surgical procedure [England, Wales and Guernsey]; and at a rate of £17.63 [gross], £14.69 [net] per surgical procedure [Northern Ireland]

NJR income streams also include industry subscription to our data and reporting services, cost recovery charges from data sharing requests and other ad hoc income.

HQIP manages the invoice subscription payment collection processes and holds the NJR budget on behalf of the NJR Steering Committee.

Surgical procedures using the following implants are subject to the charge:

  • Hips: a one-piece (monobloc) acetabular cup or a modular acetabular cup outer component.
  • Knees: any knee femoral component (including the femoral component of a unicompartmental or patellofemoral joint) or one-piece knee prosthesis.
  • Ankles: the talar metal component.
  • Elbows: a radial head component or an ulnar component. For clarity, this includes the Ulnar component (linked and unlinked), pre-assembled elbow system supplied as a unit, radial component monobloc, radial modular stem and radial lateral resurfacing head.
  • Shoulders: a humeral stem. For clarity, this includes the humeral head and stem monobloc, humeral stem modular and humeral resurfacing component.

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