How does the National Joint Registry's work benefit me? How can I become a part of the NJR's Regional Support network? Who are the working groups the NJR works with? We aim to answer all your questions whether it be in person at a conference, in our Annual Report and weekly reports or here on out website

NJR Implant Scrutiny Committee (ISC)

Chair’s report 2023 – Mr Peter Howard

Peter Howard
Mr Peter Howard
Chair NJR Implant Scrutiny Committee
Mr Peter Howard on the Implant Scrutiny Committee

The ISC comprises its Chair, surgeons, the NJR Medical Director (Deputy Chair), as well as representatives from the NJR’s core contractors: University of Bristol (our Lot 2 providers), NEC Software Solutions (our Lot 1 providers), representatives of the Medicines and Healthcare products Regulatory Agency (MHRA), representatives from the NJR Management Team and the Orthopaedic Data Evaluation Panel (ODEP)/Beyond Compliance. 

Examining the data

The registry data is refreshed and analysed every six months. The committee assesses potential outlier implant performance and notifies the MHRA when there are concerns. In addition, the committee also responds to any queries and concerns raised by surgeons and regulators, undertaking additional analysis to investigate these where necessary.

To date, the Patient Time Incidence Rate (PTIR) method has been used by the NJR in order to identify poor performance, (in line with other registries) however, it became apparent that this method alone was not sensitive enough to identify failure in sub-groups or in the longer-term. Over the last year, a new statistical methodology has been developed using Kaplan-Meier estimates; this will be tested on the second 2023 data cut, with the aim for the NJR to embrace the new methodology by the end of the year. An updated NJR Accountability and Transparency model for implant outlier monitoring will be published to reflect these changes, and engagement will take place with industry and key stakeholders.

A review of implant branding across the NJR commenced, in order to ensure consistency across manufacturers and enable a more consistent stratification of implants as part of outlier analysis.

Future developments

A working group is currently developing the processes and methodology to enable us to monitor the performance of shoulder implants more closely, in line with the current processes for hip and knee implants. This key development will ensure the NJR’s commitment to deeper levels of scrutiny in relation to implant performance.

The committee will continue to work closely with EPRD (the German registry) and ISAR (International Society of Arthroplasty Registries) on the development of an international shoulder component classification, having now agreed a comprehensive classification for hips and knees.

Implants and combinations identified as outliers

Details of implants and combinations identified as Level 1 outliers are again included in this year’s report. We encourage all surgeons to review this carefully to help inform their clinical decisions. Since the 2022 report, there have been several new notifications to the MHRA in hip and knee replacement. These have been two hip stems, two hip acetabular components and two stem/acetabular component combinations. All of these implants have been off the market for several years. In knees there have been two new Level 1 outliers, one of these is still in use (Origin Knee). Further details can be found here.

Implant library

Surgeons are now able to access a greater level of information on implant performance via our new implant library within Clinician Feedback, which is part of our NJR Connect – Data Services portal. They also have access to supplier feedback information for all implants, regardless of their outlier status, as part of this new library.

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