We have compiled all our frequently ask questions below.
The first questions are general, then those below it relate to specific joints, and below that the questions are on the RO form.
FAQ – general questions
What are the exclusion criteria for Outlier Analysis?
The exclusion criteria for each analysis are below.
Hip Mortality excludes: Trauma neck of femur Chronic Trauma Failed Hemi Metastatic 2nd Same day bilateral 2nd bilateral within 90 days same surgeon
Hip Revision excludes: Failed Hemi arthroplasty
Knee Mortality excludes: Trauma Previous Trauma 2nd Same day bilateral 2nd bilateral within 90 days same surgeon
Knee Revision excludes: Nothing
When should I stop using MDSv7 forms?
There is no confirmed end-date for submitting MDSv7 procedures currently. However, MDSv7 can only be used for procedures carried out before 12 June 2023.
I have MDSv7 forms that still need to be input to the registry – do these need to be transferred to MDSv8 forms now?
No – if the procedure has been carried out prior to 12 June 2023 they can be input using MDSv7 forms.
How can we enter the medication the patient was sent home with when the form is completed in theatre?
The surgeon may be able to inform the intended medication in theatre. This is not a mandatory field however if the information becomes available at a later date, this should be entered onto the paper form, prior to submission to the registry.
Do the paper forms indicate which fields are mandatory?
All fields are mandatory unless otherwise stated (e.g. the words ‘if available’/’optional’ after the question).
What are the main differences in Version 8 when compared to Version 7?
Information on changes can be found on NJR Centre Website – https://www.njrcentre.org.uk/healthcare-providers/update-of-njr-minimum-data-set-forms/
If the optional fields are not completed – do I still submit the form?
Yes. If the missing information is then provided at a later date, the record can be updated and re-submitted.
Is there a new version of the consent form to include the part about the patient consenting to study data linkage with NJR data? If so when will the new consent form be available?
The question about trial/study linkage refers to the patient separately consenting on the study consent form for their data to be linked to the NJR.
There is no planned change to the NJR consent form.
Now that they appear on the HR form, will hemiarthroplasty be included as part of the Best Practice Tariff calculation?
Hemiarthroplasty is not included in the Best Practice Tariff and will not be included in the calculation.
If a patient has a Manipulation Under Anaesthetic (MUA) in A&E, do we still need to record these onto the NJR?
Although the NJR will accept MUAs carried out outside of an operating theatre (eg in an emergency department), the entry of such cases is not mandatory. All MUAs taking place in an operating theatre are a mandatory part of the NJR data collection.
Is the “Chemical – At Home” field under “Thromboprophylaxis regime” mandatory, as this is not always known?
The field is mandatory but if the answer if the recommended post-discharge regime is not document in the patient record, the user should select the “None” option.
Where can I find out the answer to the section under Patient Details that states, “Has the patient consented to linkage of study data to NJR data?”
Indication as to whether a patient is taking part in a study is normally found within the patient notes or you can alternatively ask the consultant. The consultant or the research nurse/team running the study in your unit will be able to advise if the patient has consent for linkage between study data and NJR data.
In the Thromboprophylaxis regime – Chemical In Hospital and At Home section, is the At Home section used for what the patient will be sent home with? If so, will the surgeon know what the patient is going home with at the time of the procedure, or does this need to be filled in at a later date?
When a patient is admitted to hospital there is usually a “post-discharge regime” kept in the patient notes. The Consultant will typically know what the discharge medication will be. If the information becomes available at a later date, the record can be put back into edit and updated.
FAQ – Hip forms (H1 and H2)
Why include cemented hemi-arthroplasty for ‘Neck of Femur’ when it is already on the NHFD (National Hip Fracture Database), but where mortality post-operatively is measured at 30 days?
The NHFD was set up to measure the quality of care delivered to people with a hip fracture, but it is not an implant device registry. The database does not collect any detail of which components are used in each case.
When we received suggestions from the orthopaedic community to start capture data on hip hemiarthroplasty in MDSv8, we discussed with the NHFD clinical leadership team whether this was best achieved by NHFD starting to collect implant details, or by NJR starting to collect hip hemiarthroplasty. There are a number of reasons why we agreed the latter option, including the NJR’s established processes for capturing and classifying device data at scale.
The commencement of the collection of hip hemiarthroplasty on the National Joint Registry will enable us to understand the performance of these devices and to provide information to surgeons and hospitals to inform them with regard to the performance of their implant choices.
We have no plans to report surgeon or unit-level outcomes for these procedures. Unit level outcomes for all hip fractures are produced by the NHFD and this provides a more complete picture of unit performance than an analysis of hemiarthroplasty could.
Once the MDSv8 forms are in use and the ‘Neck of Femur’ procedure stats are published in the related Annual Report, will they be separated out from the elective Total Hip Replacement procedures?
Currently ‘Neck of Femur’ procedures are excluded from any analyses. They will be reported in the NJR Annual Report, but not against surgeon outcomes
On the H2 form – what do the values H1, H2 and H3 mean under the Revision Complexity section.
Hip revision complexity classification is as follows:
H1 •Acetabular bone loss •(Proprosky I, IIA) •Femoral bone loss •Paprosky I •Periprosthetic fracture •UCS A •No evidence of abductor compromise •First time revision for aseptic loosening
H2 •Acetabular bone loss •Paprosky IIb, IIC •Removal of well-fixed uncemented socket with >1cm lysis extending into ischium, pubic ramus or ilium •Femoral bone loss •Paprosky II, IIIa •Periprosthetic fracture •UCS: B1, B2 , C, D •Infection •DAIR •First time revision for infection •Evidence of abductor deficiency •Revision for dislocation
H3 •Acetabular bone loss •Paprosky IIIa, IIIb, Pelvic Discontinuity •Femoral bone loss •Paprosky IIIb, IV •Removal of well-fixed metaphyseal filling uncemented femoral stem •Periprosthetic fracture •UCS: B3, E, F •Infection •Revision for resistant or atypical organisms •Re-revision for infection •Cases requiring plastic or vascular surgical support •Revision of TFR, PFR •Re-revision for dislocations
FAQ – Knee forms (K1 and K2)
How should a focal knee resurfacing conversion be recorded?
It should be recorded on the K2 form.
RO form FAQ
On the RO form, do soft tissue repair/procedure (e.g. ligament/capsule/tendon) include the ACL and arthroscopy procedures?
An ACL repair on a joint with a joint replacement in situ (often a uni) is classed as a soft-tissue repair and recorded on an RO form.
An arthroscopic washout procedure may be recorded as ‘superficial/deep Debridement and Implant Retention’ (DAIR) or ‘washout of haematoma joint’ depending on the nature of the procedure undertaken.
An arthroscopy on a joint with a joint replacement in situ (e.g for meniscal or arthritis assessment of the remaining compartments of the knee) is not included in MDSv8 and need not be recorded.
Updated 20 July 2023